WorldWideScience

Sample records for syndrome current strategies

  1. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    Science.gov (United States)

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field.

  2. The cardiometabolic effect of current management of polycystic ovary syndrome: strategies of prevention and treatment.

    Science.gov (United States)

    Baldani, Dinka Pavicic; Skrgatic, Lana; Ougouag, Roya; Kasum, Miro

    2018-02-01

    Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder amongst women of reproductive age, which is characterized by reproductive and cardiometabolic disturbances with long-term health repercussions. Insulin resistance (IR), impaired glucose tolerance, type 2 diabetes mellitus (DM2), obesity and dyslipidemia occur more in women with PCOS than in age-comparable women without PCOS. Long term data regarding risks or benefits of medical intervention for metabolic dysfunction of PCOS are lacking. Therapies, such as oral contraceptives (OCPs) and anti-androgenic medications used to manage the reproductive manifestations of PCOS, may themselves be the cause of cardiometabolic perturbations. Hence, strategies regarding the management of reproductive issues in PCOS encompass a patient-specific tailored approach. Factors that influence the cardiometabolic side effects arising during treatment of the reproductive manifestations of PCOS (hirsutism/anovulation) are also discussed in this paper in order to build future strategies to minimize the overall cardiometabolic risk.

  3. TAFRO syndrome: current perspectives.

    Science.gov (United States)

    Sakashita, Kentaro; Murata, Kengo; Takamori, Mikio

    2018-01-01

    Multicentric Castleman's disease (MCD), a distinct subtype of Castleman's disease, is a rare, nonneoplastic, lymphoproliferative disorder. Patients with MCD present with systemic symptoms and multiple lymphadenopathy. Lymph node biopsy is necessary for the diagnosis of various histological MCD patterns including hyaline vascular, plasma cell, and mixed types. Human herpesvirus 8 (HHV8) infection was identified as an important etiology of MCD among immunocompromised patients such as those positive for human immunodeficiency virus. Although HHV8-negative MCD was reported in immunocompetent patients, the underlying etiology remains unknown. Several experts speculate that MCD in immunocompetent patients might be due to proinflammatory hypercytokinemia because of infection by a virus other than HHV8, inflammation, or neoplastic disease. In 2010, a distinct variant of HHV8-negative MCD reported in Japan was characterized by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly (TAFRO). Recent case reports and a systematic review suggest that TAFRO syndrome might have a unique pathogenesis among HHV8-negative MCD variants. This review introduces TAFRO syndrome as a subtype of HHV8-negative MCD and offers an overview of the current perspectives on this syndrome.

  4. Current strategy for treatment of patients with Wolff-Parkinson-White syndrome and asymptomatic preexcitation in Europe

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Dagres, Nikolaos; Dobreanu, Dan

    2013-01-01

    network, covering 20 countries answered the survey questions. All centres were high-volume ablation centres. A younger person with asymptomatic Wolff-Parkinson-White (WPW) pattern has a higher likelihood of being risk-stratified or receiving ablation therapy compared with an older subject. Two...... of responding centres (61-69%) report that their country lack national guidelines dealing with clinical strategies related to WPW. There is a need for national guidelines dealing with clinical strategy in patients with WPW syndrome. Older individuals with asymptomatic WPW pattern have a higher risk...

  5. Immunotherapeutic strategies in antiphospholipid syndrome.

    Science.gov (United States)

    Hoi, A Y; Ross, L; Day, J; Buchanan, R R C

    2017-03-01

    Antiphospholipid syndrome is an autoimmune condition, characterised by the persistent presence of antiphospholipid antibodies and either thrombosis or obstetric morbidity. The cornerstone of therapy is long-term anticoagulation to reduce morbidity and mortality; however, better understanding of the immunological pathways may direct us to develop future therapeutic strategies. We provide an overview of the current understanding of the immunopathogenesis of this perplexing condition and its associated morbidities and current evidence for some of the immunotherapeutic strategies. © 2017 Royal Australasian College of Physicians.

  6. Dysmobility syndrome: current perspectives

    Directory of Open Access Journals (Sweden)

    Hill KD

    2017-01-01

    Full Text Available Keith D Hill,1 Kaela Farrier,1 Melissa Russell,2 Elissa Burton1 1School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Department of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia Background: A new term, dysmobility syndrome, has recently been described as a new approach to identify older people at risk of poor health outcomes. The aim was to undertake a systematic review of the existing research literature on dysmobility syndrome.Method: All articles reporting dysmobility syndrome were identified in a systematic review of Medline (Proquest, CINAHL, PubMed, PsycInfo, EMBASE, and Scopus databases. Key characteristics of identified studies were extracted and summarized.Results: The systematic review identified five papers (three cross-sectional, one case control, and one longitudinal study. No intervention studies were identified. Prevalence of dysmobility syndrome varied between studies (22%–34% in three of the studies. Dysmobility syndrome was shown to be associated with reduced function, increased falls and fractures, and a longitudinal study showed its significant association with mortality.Conclusion: Early research on dysmobility syndrome indicates that it may be a useful classification approach to identify older people at risk of adverse health outcomes and to target for early interventions. Future research needs to standardize the optimal mix of measures and cut points, and investigate whether balance performance may be a more useful factor than history of falls for dysmobility syndrome. Keywords: mobility, elderly, functional decline

  7. Marfan syndrome: current perspectives.

    Science.gov (United States)

    Pepe, Guglielmina; Giusti, Betti; Sticchi, Elena; Abbate, Rosanna; Gensini, Gian Franco; Nistri, Stefano

    2016-01-01

    Marfan syndrome (MFS) is a pleiotropic connective tissue disease inherited as an autosomal dominant trait, due to mutations in the FBN1 gene encoding fibrillin 1. It is an important protein of the extracellular matrix that contributes to the final structure of a microfibril. Few cases displaying an autosomal recessive transmission are reported in the world. The FBN1 gene, which is made of 66 exons, is located on chromosome 15q21.1. This review, after an introduction on the clinical manifestations that leads to the diagnosis of MFS, focuses on cardiovascular manifestations, pharmacological and surgical therapies of thoracic aortic aneurysm and/or dissection (TAAD), mechanisms underlying the progression of aneurysm or of acute dissection, and biomarkers associated with progression of TAADs. A Dutch group compared treatment with losartan, an angiotensin II receptor-1 blocker, vs no other additional treatment (COMPARE clinical trial). They observed that losartan reduces the aortic dilatation rate in patients with Marfan syndrome. Later on, they also reported that losartan exerts a beneficial effect on patients with Marfan syndrome carrying an FBN1 mutation that causes haploinsufficiency (quantitative mutation), while it has no significant effect on patients displaying dominant negative (qualitative) mutations. Moreover, a French group in a 3-year trial compared the administration of losartan vs placebo in patients with Marfan syndrome under treatment with beta-receptor blockers. They observed that losartan decreases blood pressure but has no effect on aortic diameter progression. Thus, beta-receptor blockers remain the gold standard therapy in patients with Marfan syndrome. Three potential biochemical markers are mentioned in this review: total homocysteine, serum transforming growth factor beta, and lysyl oxidase. Moreover, markers of oxidative stress measured in plasma, previously correlated with clinical features of Marfan syndrome, may be explored as potential

  8. Marfan syndrome: current perspectives

    Science.gov (United States)

    Pepe, Guglielmina; Giusti, Betti; Sticchi, Elena; Abbate, Rosanna; Gensini, Gian Franco; Nistri, Stefano

    2016-01-01

    Marfan syndrome (MFS) is a pleiotropic connective tissue disease inherited as an autosomal dominant trait, due to mutations in the FBN1 gene encoding fibrillin 1. It is an important protein of the extracellular matrix that contributes to the final structure of a microfibril. Few cases displaying an autosomal recessive transmission are reported in the world. The FBN1 gene, which is made of 66 exons, is located on chromosome 15q21.1. This review, after an introduction on the clinical manifestations that leads to the diagnosis of MFS, focuses on cardiovascular manifestations, pharmacological and surgical therapies of thoracic aortic aneurysm and/or dissection (TAAD), mechanisms underlying the progression of aneurysm or of acute dissection, and biomarkers associated with progression of TAADs. A Dutch group compared treatment with losartan, an angiotensin II receptor-1 blocker, vs no other additional treatment (COMPARE clinical trial). They observed that losartan reduces the aortic dilatation rate in patients with Marfan syndrome. Later on, they also reported that losartan exerts a beneficial effect on patients with Marfan syndrome carrying an FBN1 mutation that causes haploinsufficiency (quantitative mutation), while it has no significant effect on patients displaying dominant negative (qualitative) mutations. Moreover, a French group in a 3-year trial compared the administration of losartan vs placebo in patients with Marfan syndrome under treatment with beta-receptor blockers. They observed that losartan decreases blood pressure but has no effect on aortic diameter progression. Thus, beta-receptor blockers remain the gold standard therapy in patients with Marfan syndrome. Three potential biochemical markers are mentioned in this review: total homocysteine, serum transforming growth factor beta, and lysyl oxidase. Moreover, markers of oxidative stress measured in plasma, previously correlated with clinical features of Marfan syndrome, may be explored as potential

  9. Burning mouth syndrome: Current concepts

    Directory of Open Access Journals (Sweden)

    Cibele Nasri-Heir

    2015-01-01

    Full Text Available Burning mouth syndrome (BMS is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM. The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.

  10. Burning mouth syndrome: Current concepts.

    Science.gov (United States)

    Nasri-Heir, Cibele; Zagury, Julyana Gomes; Thomas, Davis; Ananthan, Sowmya

    2015-01-01

    Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.

  11. Fragile X syndrome: Current insight

    Directory of Open Access Journals (Sweden)

    Deepika Delsa Dean

    2016-10-01

    Full Text Available Fragile X syndrome (FXS is a multigenerational disorder having massive adverse effect not only on the individuals but also on their families. It is the most common type of intellectual disability after Down’s syndrome. Over two decades have passed since the discovery of FMR1, the causal gene for FXS, but still little is known about the pathophysiology of this disease. This lack of knowledge presents the major barrier encountered by the scientific community for early diagnosis and effective treatment. Since early diagnosis has important implication in determining the disease status among members of the family tree so the genetic counseling and supportive therapy get hampered in larger perspective. The present review emphasizes on the recent findings in FXS pathophysiology, therapeutics and technical challenges in molecular diagnosis.

  12. Burning mouth syndrome: Current concepts

    OpenAIRE

    Nasri-Heir, Cibele; Zagury, Julyana Gomes; Thomas, Davis; Ananthan, Sowmya

    2015-01-01

    Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also rep...

  13. Prostate carcinoma: current diagnostic strategy

    International Nuclear Information System (INIS)

    Schwarzschild, Monica Maria Agata Stiepcich; Ferraz, Maria Lucia Cardoso Gomes; Oliveira, Jose Marcelo Amatuzzi; Andriolo, Adagmar

    2001-01-01

    Prostate cancer is the second cause of cancer death in men in the Western world. Despite progress in the treatment of advanced disease, it is recognized that the only possibility of reduction in prostate cancer death is nearly diagnosis when the disease is localized. In the present study our aim was to review the current strategy for diagnosis of prostate carcinoma. Prostate-specific antigen (PSA) is a valuable tumor marker and has demonstrated effectiveness in detecting prostate carcinoma, monitoring therapeutic efficacy, and disclosing disease recurrence. However, alternative methods are been proposed just as the free to total PSA ratio, PSA density, PSA velocity, which could improve the diagnostic sensibility and the specificity. Image diagnostic methods include transrectal ultra sound, computerized tomography, magnetic resonance image, and bone cintigraphy. The ultra sound is the best approach to guide the prostate biopsy and, together with the magnetic resonance is still useful for loco regional graduation. Computerized tomography as magnetic resonance image can be used for identification of linfonodal involvement. Bone cintigraphy is the best method for the identification of metastatic disease. (author)

  14. Current strategy for treatment of patients with Wolff-Parkinson-White syndrome and asymptomatic preexcitation in Europe: European Heart Rhythm Association survey.

    Science.gov (United States)

    Svendsen, Jesper Hastrup; Dagres, Nikolaos; Dobreanu, Dan; Bongiorni, Maria Grazia; Marinskis, Germanas; Blomström-Lundqvist, Carina

    2013-05-01

    clinical strategy in patients with WPW syndrome. Older individuals with asymptomatic WPW pattern have a higher risk of not receiving risk stratification or curative therapy with ablation compared with younger patients, despite the higher risk of developing atrial fibrillation.

  15. Irritable bowel syndrome: contemporary nutrition management strategies.

    Science.gov (United States)

    Mullin, Gerard E; Shepherd, Sue J; Chander Roland, Bani; Ireton-Jones, Carol; Matarese, Laura E

    2014-09-01

    Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome. © 2014 American Society for Parenteral and Enteral Nutrition.

  16. Subclinical Cushing's syndrome: current concepts and trends.

    Science.gov (United States)

    Zografos, George N; Perysinakis, Iraklis; Vassilatou, Evangeline

    2014-01-01

    Clinically inapparent adrenal masses which are incidentally detected have become a common problem in everyday practice. Approximately 5-20% of adrenal incidentalomas present subclinical cortisol hypersecretion which is characterized by subtle alterations of the hypothalamic-pituitary-adrenal axis due to adrenal autonomy. This disorder has been described as subclinical Cushing's syndrome, since there is no typical clinical phenotype. The diagnosis of subclinical Cushing's syndrome is based on biochemical evaluation; however, there is still no consensus for the biochemical diagnostic criteria. An abnormal 1mg dexamethasone suppression test (DST) as initial screening test in combination with at least one other abnormal test of the hypothalamic-pituitary-adrenal axis has been advocated by most experts for the diagnosis of subclinical Cushing's syndrome. DST is the main method of establishing the diagnosis, while there is inhomogeneity of the information that other tests provide. Arterial hypertension, diabetes mellitus type 2 or impaired glucose tolerance, central obesity, osteoporosis/vertebral fractures and dyslipidemia are considered as detrimental effects of chronic subtle cortisol excess, although there is no proven causal relationship between subclinical cortisol hypersecretion and these morbidities. Therapeutic strategies include careful observation along with medical treatment of morbidities potentially related to subtle cortisol hypersecretion versus laparoscopic adrenalectomy. The optimal management of patients with subclinical Cushing's syndrome is not yet defined. The conservative approach is appropriate for the majority of these patients; however, the duration of follow-up and the frequency of periodical evaluation still remain open issues. Surgical resection may be beneficial for patients with hypertension, diabetes mellitus type 2 or abnormal glucose tolerance and obesity.

  17. Current Strategies in Cardiovascular Biomaterial Functionalization

    Directory of Open Access Journals (Sweden)

    Karla Lehle

    2010-01-01

    Full Text Available Prevention of the coagulation cascade and platelet activation is the foremost demand for biomaterials in contact with blood. In this review we describe the underlying mechanisms of these processes and offer the current state of antithrombotic strategies. We give an overview of methods to prevent protein and platelet adhesion, as well as techniques to immobilize biochemically active molecules on biomaterial surfaces. Finally, recent strategies in biofunctionalization by endothelial cell seeding as well as their possible clinical applications are discussed.

  18. Current NATO strategy and no first use

    International Nuclear Information System (INIS)

    Lubkemeier, E.

    1988-01-01

    This paper reports that spurred by the public controversy about the implementation of the NATO dual-track decision, the Western Alliance is currently in the third phase of its strategy debate. The first phase ended in 1967 with the official adoption of the doctrine of massive retaliation whose center-piece was NATO's threat to respond to a Soviet attack in Europe by an early and if need be massive use of nuclear weapons. Soon thereafter this concept was called in question in the US. The critics pointed out that at a time where its vulnerability to Soviet nuclear strikes was growing (the so-called Sputnik shock of 1957 played a special role in this context), it was too risky for the United States to stumble into a nuclear exchange with the USSR over any outbreak of an armed East-West confrontation in Europe. They therefore propounded that the over-reliance of the West's deterrence on nuclear arms be diminished in favor of a stronger conventional deterrent. With the advent of the Kennedy administration in January 1961, this stance became official American policy and was expounded to the European members of the Alliance by then Secretary of Defence McNamara. This second phase of the strategy debate was concluded in 1967 by promulgating the current strategy of Flexible Response

  19. Nelson syndrome: historical perspectives and current concepts.

    Science.gov (United States)

    Hornyak, Mark; Weiss, Martin H; Nelson, Don H; Couldwell, William T

    2007-01-01

    The appearance of an adrenocorticotropic hormone (ACTH)-producing tumor after bilateral adrenalectomy for Cushing disease was first described by Nelson in 1958. The syndrome that now bears his name was characterized by hyperpigmentation, a sellar mass, and increased plasma ACTH levels. The treatment of Cushing disease has changed drastically since the 1950s, when the choice was adrenalectomy. Thus, the occurrence, diagnosis, and treatment of Nelson syndrome have changed as well. In the modern era of high-resolution neuroimaging, transsphenoidal microneurosurgery, and stereotactic radiosurgery, Nelson syndrome has become a rare entity. The authors describe the history of the diagnosis and treatment of Nelson syndrome. In light of the changes described, the authors believe this disease must be reevaluated in the contemporary era and a modern paradigm adopted.

  20. Antiphospholipid Syndrome Laboratory Testing and Diagnostic Strategies

    Science.gov (United States)

    Ortel, Thomas L.

    2016-01-01

    The Antiphospholipid Syndrome (APS) is diagnosed in patients with recurrent thromboembolic events and/or pregnancy loss in the presence of persistent laboratory evidence for antiphospholipid antibodies. Diagnostic tests for the detection of antiphospholipid antibodies include laboratory assays that detect anticardiolipin antibodies, lupus anticoagulants, and anti-β2-glycoprotein I antibodies. These assays have their origins beginning more than sixty years ago, with the identification of the biologic false positive test for syphilis, the observation of ‘circulating anticoagulants’ in certain patients with systemic lupus erythematosus, the identification of cardiolipin as a key component in the serologic test for syphilis, and the recognition and characterization of a ‘cofactor’ for antibody binding to phospholipids. Although these assays have been used clinically for many years, there are still problems with the accurate diagnosis of patients with this syndrome. For example, lupus anticoagulant testing can be difficult to interpret in patients receiving anticoagulant therapy, but most patients with a thromboembolic event will already be anticoagulated before the decision to perform the tests has been made. In addition to understanding limitations of the assays, clinicians also need to be aware of which patients should be tested and not obtain testing on patients unlikely to have APS. New tests and diagnostic strategies are in various stages of development and should help improve our ability to accurately diagnose this important clinical disorder. PMID:22473619

  1. Current issues and strategies for transmission planning

    Energy Technology Data Exchange (ETDEWEB)

    Isaacs, A.L. [Electranix, Winnipeg, MB (Canada); Rajapakse, A. [Manitoba Univ., Winnipeg, MB (Canada)

    2008-07-01

    Following the widespread deregulation of the electric power industry in the early 1990s, significant changes occurred in the regulatory and planning environments of the industry. Several regions of North America remain fully or partially regulated in the traditional sense including most Canadian provinces, except for Alberta and Ontario. Although the Mexican system has separate generation and transmission companies and current restructuring efforts are underway, all companies are state-owned, and private investment in energy is heavily constrained by the Mexican constitution. In these regulated regions, traditional generation and transmission expansion planning methods remain in use. This paper presented an overview of current trends in transmission planning strategies that have evolved in response to the restructuring of the power industry, and a conceptual framework of a procedure that would guide planners faced with the challenges of incorporating large scale wind generation in deregulated environments. The paper provided background information on the effect of deregulation on transmission planning. Planning strategies that were discussed included quantifying risk to help identify best alternatives; use of reference systems to estimate generator costs and reduce uncertainty; project based transmission expansion; transmission construction ahead of generation; and generation ahead of transmission. The impact of wind on transmission planning as well as future work addressing challenges posed by wind were also addressed. Research is continuing in this area to illustrate the concepts proposed through a detailed case study. 15 refs., 2 figs.

  2. Molecular imaging: current status and emerging strategies

    International Nuclear Information System (INIS)

    Pysz, M.A.; Gambhir, S.S.; Willmann, J.K.

    2010-01-01

    In vivo molecular imaging has a great potential to impact medicine by detecting diseases in early stages (screening), identifying extent of disease, selecting disease- and patient-specific treatment (personalized medicine), applying a directed or targeted therapy, and measuring molecular-specific effects of treatment. Current clinical molecular imaging approaches primarily use positron-emission tomography (PET) or single photon-emission computed tomography (SPECT)-based techniques. In ongoing preclinical research, novel molecular targets of different diseases are identified and, sophisticated and multifunctional contrast agents for imaging these molecular targets are developed along with new technologies and instrumentation for multi-modality molecular imaging. Contrast-enhanced molecular ultrasound (US) with molecularly-targeted contrast microbubbles is explored as a clinically translatable molecular imaging strategy for screening, diagnosing, and monitoring diseases at the molecular level. Optical imaging with fluorescent molecular probes and US imaging with molecularly-targeted microbubbles are attractive strategies as they provide real-time imaging, are relatively inexpensive, produce images with high spatial resolution, and do not involve exposure to ionizing irradiation. Raman spectroscopy/microscopy has emerged as a molecular optical imaging strategy for ultrasensitive detection of multiple biomolecules/biochemicals with both in vivo and ex vivo versatility. Photoacoustic imaging is a hybrid of optical and US techniques involving optically-excitable molecularly-targeted contrast agents and quantitative detection of resulting oscillatory contrast agent movement with US. Current preclinical findings and advances in instrumentation, such as endoscopes and microcatheters, suggest that these molecular imaging methods have numerous potential clinical applications and will be translated into clinical use in the near future.

  3. Developing syndrome definitions based on consensus and current use

    Science.gov (United States)

    Dowling, John N; Baer, Atar; Buckeridge, David L; Cochrane, Dennis; Conway, Michael A; Elkin, Peter; Espino, Jeremy; Gunn, Julia E; Hales, Craig M; Hutwagner, Lori; Keller, Mikaela; Larson, Catherine; Noe, Rebecca; Okhmatovskaia, Anya; Olson, Karen; Paladini, Marc; Scholer, Matthew; Sniegoski, Carol; Thompson, David; Lober, Bill

    2010-01-01

    Objective Standardized surveillance syndromes do not exist but would facilitate sharing data among surveillance systems and comparing the accuracy of existing systems. The objective of this study was to create reference syndrome definitions from a consensus of investigators who currently have or are building syndromic surveillance systems. Design Clinical condition–syndrome pairs were catalogued for 10 surveillance systems across the United States and the representatives of these systems were brought together for a workshop to discuss consensus syndrome definitions. Results Consensus syndrome definitions were generated for the four syndromes monitored by the majority of the 10 participating surveillance systems: Respiratory, gastrointestinal, constitutional, and influenza-like illness (ILI). An important element in coming to consensus quickly was the development of a sensitive and specific definition for respiratory and gastrointestinal syndromes. After the workshop, the definitions were refined and supplemented with keywords and regular expressions, the keywords were mapped to standard vocabularies, and a web ontology language (OWL) ontology was created. Limitations The consensus definitions have not yet been validated through implementation. Conclusion The consensus definitions provide an explicit description of the current state-of-the-art syndromes used in automated surveillance, which can subsequently be systematically evaluated against real data to improve the definitions. The method for creating consensus definitions could be applied to other domains that have diverse existing definitions. PMID:20819870

  4. Current strategy for the imaging of neuroblastoma

    International Nuclear Information System (INIS)

    Brisse, H.; Neuenschwander, S.; Edeline, V.; Michon, J.; Zucker, J.M.; Couanet, D.

    2001-01-01

    Advances in the management of neuroblastoma lead radiologists and nuclear medicine specialists to optimize their procedures in order to propose a rational use of their techniques, adjusted to the various clinical presentations and to therapeutic management. The aim of this paper is to assess the imaging procedures for the diagnosis and follow-up of neuroblastoma in children according to current therapeutic European protocols. An imaging strategy at diagnosis is first proposed: optimal assessment of local extension of the primary tumour is made with MRI, or spiral-CT when MRI is not available, for all locations except for abdominal tumours for which CT remains the best imaging modality. Metastatic extension is assessed with mlBG scan and liver sonography. Indications for bone metastasis evaluation with either radiological or radionuclide techniques are detailed. Imaging follow-up during treatment for metastatic or unresectable tumours is described. A check-list of radiological main points to be evaluated before surgery is proposed for localized neuroblastoma. The imaging strategy for the diagnosis of 'occult' neuroblastoma is considered. Finally, we explain the management of neuroblastoma detected during the prenatal or neonatal period. (authors)

  5. Restless Legs Syndrome with Current Diagnostic Criteria

    Directory of Open Access Journals (Sweden)

    Meral Bilgilisoy Filiz

    2015-08-01

    Full Text Available Restless legs syndrome (RLS, also known as Willis-Ekbom disease, is a chronic movement disorder, characterized by an urge to move legs usually accompanied by uncomfortable sensations and sleep disorders. The prevalence of the syndrome ranges from 1% to 15% in the general population, and about 2% during childhood. RLS is the most common movement disorder in pregnancy. However RLS still remains underdiagnosed probably due to lack of accurate information about the disease. Family history is positive in 50-70% of the primary RLS patients. The secondary form of the syndrome is associated with iron deficiency, renal failure, pregnancy, diabetes mellitus and many rheumatologic disorders. Secondary forms generally manifest at older ages and have a rapid progression with a poorer prognosis. The pathophysiology of RLS is focused on the dopaminergic system, reduced central nervous system iron levels and genetic linkages. Diagnosis is based on clinical features and the diagnostic criteria suggested by International RLS Study Group. Secondary causes must be carefully investigated before the treatment. In mild forms of the disease non-pharmacologic therapies might be useful, while in moderate or severe forms of the disease generally pharmacologic therapies such as dopamine agonists, anticonvulsants, opioids and benzodiazepines are required. (Turkish Journal of Osteoporosis 2015;21: 87-95

  6. Current Understanding of Usher Syndrome Type II

    Science.gov (United States)

    Yang, Jun; Wang, Le; Song, Hongman; Sokolov, Maxim

    2012-01-01

    Usher syndrome is the most common deafness-blindness caused by genetic mutations. To date, three genes have been identified underlying the most prevalent form of Usher syndrome, the type II form (USH2). The proteins encoded by these genes are demonstrated to form a complex in vivo. This complex is localized mainly at the periciliary membrane complex in photoreceptors and the ankle-link of the stereocilia in hair cells. Many proteins have been found to interact with USH2 proteins in vitro, suggesting that they are potential additional components of this USH2 complex and that the genes encoding these proteins may be the candidate USH2 genes. However, further investigations are critical to establish their existence in the USH2 complex in vivo. Based on the predicted functional domains in USH2 proteins, their cellular localizations in photoreceptors and hair cells, the observed phenotypes in USH2 mutant mice, and the known knowledge about diseases similar to USH2, putative biological functions of the USH2 complex have been proposed. Finally, therapeutic approaches for this group of diseases are now being actively explored. PMID:22201796

  7. Metabolic syndrome in children: current issues and South Asian perspective.

    Science.gov (United States)

    Misra, Anoop; Khurana, Lokesh; Vikram, Naval K; Goel, Ashish; Wasir, Jasjeet S

    2007-01-01

    The objective of this review is to discuss definition, determinants, and management issues of the metabolic syndrome in children with a focus on South Asians. The literature search was done using the PubMed search engine (National Library of Medicine, Bethesda, MD, USA). Manual searches for other important references and medical databases were also done. There is a need for an integrated definition of the metabolic syndrome in children and adolescents, taking cognizance of the ethnic-specific variations. Obesity and body fat patterning are important determinants of insulin resistance and the metabolic syndrome in children and ethnic variations in these parameters are seen. Excess body fat and thicker truncal subcutaneous fat are important predisposing factors for development of insulin resistance in South Asian children. Because the metabolic syndrome tracks into adulthood, its manifestations need to be recognized early for prevention of diabetes and coronary heart disease. Therapeutic lifestyle changes, maintenance of high levels of physical activity and normal weight are most important strategies; pharmacologic therapy for individual components of the metabolic syndrome is occasionally needed. The metabolic syndrome in children is an important clinical marker of diabetes and coronary heart disease in adults. In view of the rapid increase in the metabolic syndrome in most populations, high-risk screening and effective public-intervention educational programs are urgently needed.

  8. Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

    OpenAIRE

    Bilgen Erdoğan; Murat Yılmaz

    2012-01-01

    Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

  9. Current Treatment Options in Challenging Oral Diseases: Burning Mouth Syndrome

    Directory of Open Access Journals (Sweden)

    Bilgen Erdoğan

    2012-12-01

    Full Text Available Burning mouth syndrome is a chronic condition characterized by burning pain without any signs of an oral mucosal pathology, that usually affects postmenopausal women. Burning sensation is often accompanied by dysgeusia and xerostomia. The pathogenesis of the disease is unknown and an effective treatment option for most of the patients has not been defined yet. The aim of this review is to present current pharmacological and physicological treatments of burning mouth syndrome.

  10. The cannabis withdrawal syndrome: current insights

    Science.gov (United States)

    Bonnet, Udo; Preuss, Ulrich W

    2017-01-01

    The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to

  11. The cannabis withdrawal syndrome: current insights

    Directory of Open Access Journals (Sweden)

    Bonnet U

    2017-04-01

    Full Text Available Udo Bonnet,1,2 Ulrich W Preuss3,4 1Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel, 2Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen, 3Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn, 4Martin Luther University Halle-Wittenberg, Halle (Saale, Germany Abstract: The cannabis withdrawal syndrome (CWS is a criterion of cannabis use disorders (CUDs (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition and cannabis dependence (International Classification of Diseases [ICD]-10. Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1 receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox and

  12. Current Evidence Supporting Obstetric Fistula Prevention Strategies ...

    African Journals Online (AJOL)

    Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and prevalence of the disease, identify the ...

  13. Hydropericardium syndrome: current state and future developments.

    Science.gov (United States)

    Asthana, Manu; Chandra, Rajesh; Kumar, Rajesh

    2013-05-01

    Hydropericardium syndrome (HPS) is a highly infectious disease caused by fowl adenovirus serotype 4 (FAV-4) affecting poultry, especially broiler birds. The disease was initially reported from Angara Goth, Pakistan, and then from India during 1994, in the poultry belt of Jammu and Kashmir, and thereafter, from almost all parts of the country, causing heavy economic losses to the poultry industry. The disease occurs predominantly in broilers of the age group of 3-5 weeks, characterized by sudden onset of high mortality up to 80 %. The causative agent of HPS is fowl adenovirus 4, which is a member of the species Fowl Adenovirus C, genus Aviadenovirus, family Adenoviridae [60]. FAV-4 is non-enveloped and icosahedral in shape, measuring 70-90 nm in size and containing a linear dsDNA of approximately 45 kb in size as its genome. The livers of affected birds show necrotic foci and basophilic intranuclear inclusion bodies in the hepatocytes. The disease can be diagnosed from its gross and microscopic changes in the liver and by various serological tests, such as agar gel immunodiffusion, counterimmunoelectrophoresis, indirect haemagglutination, fluorescent antibody techniques, and ELISA. In the past few years, PCR has been used as a rapid diagnostic tool for the detection of fowl adenoviruses. The disease has been brought under control by the use of formalin-inactivated, attenuated or live vaccines in experimentally infected birds. Advancement in the field of computational immunology accelerates knowledge acquisition and simultaneously reduces the time and effort involved in screening potential epitopes, leading toward the development of epitope-based vaccines.

  14. Thoracic endometriosis syndrome: Current concept in ...

    African Journals Online (AJOL)

    Background: Thoracic endometriosis is a rare pathology. The diagnosis is often delayed or missed, however recently, there has been significant advances in the knowledge of this condition and hence, an improvement in the diagnosis and treatment. Objective: To review the current concepts in the pathophysiology and ...

  15. Metabolic syndrome in the Mediterranean region: Current status

    Directory of Open Access Journals (Sweden)

    Panagiotis Anagnostis

    2012-01-01

    Full Text Available Metabolic syndrome (MetS is a cluster of metabolic abnormalities including abdominal obesity, impaired fasting glucose, hypertension and dyslipidemia. It seems to affect about one-fourth to one-fifth of the Mediterranean population, and its prevalence increases with age, being similar for both sexes and depending on the region and the definition used, with the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATPIII definition being the most effective in the identification of glucose intolerance and cardiovascular risk. Except for these, MetS is associated with fatty liver disease, some forms of cancer, hypogonadism, and vascular dementia. The Mediterranean diet seems to be an ideal diet in patients with MetS, being rich in fibre, monounsaturated and polyunsaturated fats, and low in animal protein; and decreases the prevalence of MetS and cardiovascular disease risk. Except for weight loss, multifactorial intervention including insulin resistance reduction and normoglycemia, management of dyslipidemia, optimizing blood pressure and administration of low-dose aspirin for patients at high or moderately high cardiovascular disease (CVD risk are additional targets. The present review provides current understanding about MetS in the Mediterranean region, focusing on its prevalence, clinical significance, and therapeutic strategy.

  16. Metabolic syndrome in the Mediterranean region: Current status.

    Science.gov (United States)

    Anagnostis, Panagiotis

    2012-01-01

    Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including abdominal obesity, impaired fasting glucose, hypertension and dyslipidemia. It seems to affect about one-fourth to one-fifth of the Mediterranean population, and its prevalence increases with age, being similar for both sexes and depending on the region and the definition used, with the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATPIII) definition being the most effective in the identification of glucose intolerance and cardiovascular risk. Except for these, MetS is associated with fatty liver disease, some forms of cancer, hypogonadism, and vascular dementia. The Mediterranean diet seems to be an ideal diet in patients with MetS, being rich in fibre, monounsaturated and polyunsaturated fats, and low in animal protein; and decreases the prevalence of MetS and cardiovascular disease risk. Except for weight loss, multifactorial intervention including insulin resistance reduction and normoglycemia, management of dyslipidemia, optimizing blood pressure and administration of low-dose aspirin for patients at high or moderately high cardiovascular disease (CVD) risk are additional targets. The present review provides current understanding about MetS in the Mediterranean region, focusing on its prevalence, clinical significance, and therapeutic strategy.

  17. Current Immunotherapeutic Strategies to Enhance Oncolytic Virotherapy

    Directory of Open Access Journals (Sweden)

    Daniel E. Meyers

    2017-06-01

    Full Text Available Oncolytic viruses (OV represent a promising strategy to augment the spectrum of cancer therapeutics. For efficacy, they rely on two general mechanisms: tumor-specific infection/cell-killing, followed by subsequent activation of the host’s adaptive immune response. Numerous OV genera have been utilized in clinical trials, ultimately culminating in the 2015 Food and Drug Administration approval of a genetically engineered herpes virus, Talminogene laherparepvec (T-VEC. It is generally accepted that OV as monotherapy have only modest clinical efficacy. However, due to their ability to elicit specific antitumor immune responses, they are prime candidates to be paired with other immune-modulating strategies in order to optimize therapeutic efficacy. Synergistic strategies to enhance the efficacy of OV include augmenting the host antitumor response through the insertion of therapeutic transgenes such as GM-CSF, utilization of the prime-boost strategy, and combining OV with immune-modulatory drugs such as cyclophosphamide, sunitinib, and immune checkpoint inhibitors. This review provides an overview of these immune-based strategies to improve the clinical efficacy of oncolytic virotherapy.

  18. Malaria vector control: current and future strategies

    NARCIS (Netherlands)

    Takken, W.; Knols, B.G.J.

    2009-01-01

    The recently announced call for malaria eradication represents a new page in the history of this disease. This has been triggered by remarkable reductions in malaria resulting from combined application of effective drugs and vector control. However, this strategy is threatened by development of

  19. Polycystic ovary syndrome: current status and future perspective

    Science.gov (United States)

    Barthelmess, Erin K.; Naz, Rajesh K.

    2015-01-01

    Polycystic ovary syndrome (PCOS) is a widespread reproductive disorder that encompasses many associated health conditions and has an impact on various metabolic processes. PCOS is depicted by hyperandrogenism, polycystic ovaries, and anovulation. It increases the risk of insulin resistance (IR), type 2 diabetes, obesity, and cardiovascular disease. The etiology of the disease remains unclear, and the subjective phenotype makes a united diagnosis difficult among physicians. It seems to be a familial genetic syndrome caused by a combination of environmental and genetic factors. It can be linked with metabolic disorders in first-degree family members. PCOS is the cause of up to 30% of infertility in couples seeking treatment. Currently, there is no cure for PCOS. Despite the growing incidence of this syndrome, limited research has been done that encompasses the entirety of PCOS spectrum. In this review, the current status and possible future perspective will be discussed. PMID:24389146

  20. Past and current cause-specific mortality in Eisenmenger syndrome

    DEFF Research Database (Denmark)

    Hjortshøj, Cristel M Sørensen; Kempny, Aleksander; Jensen, Annette Schophuus

    2017-01-01

    Aims: Eisenmenger syndrome (ES) is associated with considerable morbidity and mortality. Therapeutic strategies have changed during the 2000s in conjunction with an emphasis on specialist follow-up. The aim of this study was to determine the cause-specific mortality in ES and evaluate any relevan...... rather than acute cardiac causes, primarily heart failure, whereas peri-procedural and deaths due to haemoptysis have become less common. Lifelong vigilance in tertiary centres and further research for ES are clearly needed....

  1. Tissue Engineering: Current Strategies and Future Directions

    OpenAIRE

    Olson, Jennifer L.; Atala, Anthony; Yoo, James J.

    2011-01-01

    Novel therapies resulting from regenerative medicine and tissue engineering technology may offer new hope for patients with injuries, end-stage organ failure, or other clinical issues. Currently, patients with diseased and injured organs are often treated with transplanted organs. However, there is a shortage of donor organs that is worsening yearly as the population ages and as the number of new cases of organ failure increases. Scientists in the field of regenerative medicine and tissue eng...

  2. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

    Directory of Open Access Journals (Sweden)

    Vedantam Rajshekhar

    2016-01-01

    Full Text Available Neurocysticercosis (NCC is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues.

  3. Neurocysticercosis: Diagnostic problems & current therapeutic strategies

    Science.gov (United States)

    Rajshekhar, Vedantam

    2016-01-01

    Neurocysticercosis (NCC) is the most common single cause of seizures/epilepsy in India and several other endemic countries throughout the world. It is also the most common parasitic disease of the brain caused by the cestode Taenia solium or pork tapeworm. The diagnosis of NCC and the tapeworm carrier (taeniasis) can be relatively inaccessible and expensive for most of the patients. In spite of the introduction of several new immunological tests, neuroimaging remains the main diagnostic test for NCC. The treatment of NCC is also mired in controversy although, there is emerging evidence that albendazole (a cysticidal drug) may be beneficial for patients by reducing the number of seizures and hastening the resolution of live cysts. Currently, there are several diagnostic and management issues which remain unresolved. This review will highlight some of these issues. PMID:28139530

  4. Antibiotic resistance: current issues and future strategies

    Directory of Open Access Journals (Sweden)

    Giancarlo Scarafile

    2016-09-01

    Full Text Available The antibiotic resistance (antimicrobial resistance – AMR and the particular emergence of multi-resistant bacterial strains, is a problem of clinical relevance involving serious threats to public health worldwide. From early this decade, a lot of studies have demonstrated a significant increase in the rates of antibiotic resistance by bacterial pathogens responsible for nosocomial and community infections all over the world. The AMR leads to a reduced drug efficacy in the treatment options available and therefore, to an increase in mortality rates. The original causes of the phenomenon are: environmental factors which favor a mutation of the genetic bacterial inheritance, thereby inhibiting the active ingredient of the antibiotics; unsuitable administering of antibiotics in veterinary, incorrect taking both in hospitals and at home and, lately, lack of investments in the development of new drugs. The alarming epidemiological data prompted the World Health Organization (WHO in 2011 to coin the slogan "No action today, no cure tomorrow" in order to immediately implement a new strategy to improve the use of available drugs and to accelerate the introduction of new ones through a new phase of research involving private and public institutions. The European Union has stressed that the surveillance is considered an essential factor for an effective response to this problem but it has also highlighted that the results produced have been lower than expectations because of serious shortcomings such as lack of methodological standards, insufficient data sharing and no coordination among European countries. In Italy the situation is much more troubling; in fact, according to the Ministry of Health, 5000-7000 yearly deaths are deemed due to nosocomial infections, with an annual cost of more than 100 million €.These figures explain how the fight against infections is far from being won. The purpose of this review is to analyze the basic causes of the

  5. Prevention of OHSS: Current strategies and new insights

    Directory of Open Access Journals (Sweden)

    Cristiano E. Busso

    2010-10-01

    Full Text Available Ovarian hyperstimulation syndrome (OHSS is an iatrogenic and potentially life threatening condition that affects young healthy patients. Many strategies have been proposed to prevent this syndrome. However, to avoid OHSS without compromising on IVF outcome is still a challenge. The most important action is to identify patients at risk even before ovarian stimulation is initiated and to give them special attention. Coasting is the most popular method to avoid/minimize OHSS. Cycle cancellation, cryopreservation, GnRH antagonists, GnRH agonists, i.v. albumin are other strategies that can provide some kind of benefit but do not completely avoid both early and late forms of OHSS and/or cannot be applied to every patient. Recent studies demonstrate that dopamine agonists can prevent or minimize OHSS without affecting IVF outcome but clinical protocols are not well established yet.

  6. A Positive Diagnostic Strategy Is Noninferior to a Strategy of Exclusion for Patients With Irritable Bowel Syndrome

    DEFF Research Database (Denmark)

    Begtrup, Luise M; Engsbro, Anne Line; Kjeldsen, Jens

    2013-01-01

    . No cases of inflammatory bowel disease, colorectal cancer, or celiac disease were found. CONCLUSIONS: In diagnosing IBS in primary care, use of a positive diagnostic strategy is noninferior to using a strategy of exclusion with regard to the patients' HRQOL. Our findings support the current guideline......BACKGROUND & AIMS: Guidelines recommend a positive strategy based on symptom criteria to diagnose patients with irritable bowel syndrome (IBS). We conducted a randomized noninferiority trial to determine whether a positive diagnostic strategy is noninferior to a strategy of exclusion, with regard...... year between groups (on the basis of the Short Form 36 health survey, physical component summary, and noninferiority margin of 3 points). Secondary outcomes were change in gastrointestinal symptoms, satisfaction with management, and use of resources. Findings of diagnostic misclassification were...

  7. Gulf War Syndrome: a review of current knowledge and understanding.

    Science.gov (United States)

    Minshall, D

    2014-01-01

    The 1991 Persian Gulf War was a resounding military success for coalition forces, who liberated Kuwait following the Iraqi invasion. The medical legacy we have from the conflict is the poorly understood, yet remarkable, phenomenon of Gulf War Syndrome, which surfaced soon after. Epidemiological research has proven beyond doubt that Gulf War veterans report a wide variety of symptoms, in excess of appropriately matched control subjects, and experience worse general health. Numerous toxic environmental hazards have been suggested as causes of Gulf War Syndrome, yet exhaustive scientific study has failed to provide conclusive proof of any link. No novel or recognised disease has been found to account for the symptomatic burden of veterans, and the optimal treatment remains uncertain. This understanding can be added to from an anthropological perspective, where the narratives of those afflicted provide further insight. The nature of military life was changing at the time of the Gulf War, challenging the identity and beliefs of some veterans and causing socio-cultural distress. The symptomatic presentation of Gulf War Syndrome can be considered an articulation of this disharmony. Gulf War Syndrome can also be considered within the group of post-combat disorders such as shellshock, the like of which have occurred after major wars in the last century. With the current withdrawal from Afghanistan, the Defence Medical Services (DMS) should heed the lessons of history.

  8. Treatment strategies for tics in Tourette syndrome

    Science.gov (United States)

    Eddy, Clare M.; Rickards, Hugh E.; Cavanna, Andrea E.

    2011-01-01

    Tourette syndrome (TS) is a chronic neurodevelopmental disorder characterized by tics: repetitive, involuntary movements and vocalizations. These symptoms can have a significant impact on patients’ daily functioning across many domains. Tics tend to be most severe in child and adolescent sufferers, so their presence has the potential to impact a period of life that is both critical for learning and is often associated with the experience of greater social tension and self-consciousness than adulthood. Furthermore, control over tics that lead to physical impairment or self-injurious behaviour is of vital importance in maintaining health and quality of life. There are numerous complicating factors in the prescription of treatment for tics, due to both the side effects associated with alleviating agents and patient characteristics, such as age and comorbid conditions. This review summarizes literature pertaining to the efficacy and safety of both traditionally prescribed and more modern medications. We also discuss the merits of behavioural and surgical techniques and highlight newer emerging treatments. Although treatment response is to some extent variable, there are a number of agents that are clearly useful as first-line treatments for TS. Other interventions may be of most benefit to patients exhibiting refractory tics or more specific symptom profiles. PMID:21339906

  9. Invasive strategy and frailty in very elderly patients with acute coronary syndromes.

    Science.gov (United States)

    Llaó, Isaac; Ariza-Solé, Albert; Sanchis, Juan; Alegre, Oriol; López-Palop, Ramon; Formiga, Francesc; Marín, Francisco; Vidán, María T; Martínez-Sellés, Manuel; Sionis, Alessandro; Vives-Borrás, Miguel; Gómez-Hospital, Joan Antoni; Gómez-Lara, Josep; Roura, Gerard; Díez-Villanueva, Pablo; Núñez-Gil, Iván; Maristany, Jaume; Asmarats, Lluis; Bueno, Héctor; Abu-Assi, Emad; Cequier, Àngel

    2018-04-03

    Current guidelines recommend an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes (NSTEACS). The role of an invasive strategy in frail elderly patients remains controversial. The LONGEVO-SCA registry included unselected NSTEACS patients aged ≥80 years. A geriatric assessment was performed during hospitalization, including frailty. We evaluated the impact of an invasive strategy during the admission on the incidence of cardiac death, reinfarction or new revascularisation at 6-months. From 531 patients included, 145 (27.3%) were frail. Mean age was 84.3 years. Most patients underwent an invasive strategy (407/531, 76.6%). Patients undergoing an invasive strategy were younger and had lower proportion of frailty (23.3% vs 40.3%, pstrategy-frailty was significant (p=0.032) Conclusions: An invasive strategy was independently associated with better outcomes in very elderly patients with NSTEACS. This association was different according to frailty status.

  10. Cataract surgery in patients with pseudoexfoliation syndrome: current updates

    Directory of Open Access Journals (Sweden)

    Fontana L

    2017-07-01

    Full Text Available Luigi Fontana, Marco Coassin, Alfonso Iovieno, Antonio Moramarco, Luca Cimino Ophthalmology Unit, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc., the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Keywords: pseudoexfoliation syndrome, cataract surgery, zonular laxity, intraocular lens implant, complications

  11. A Synthesis of Language Learning Strategies: Current Issues, Problems and Claims Made in Learner Strategy Research

    Science.gov (United States)

    Barjesteh, Hamed; Mukundan, Jayakaran; Vaseghi, Reza

    2014-01-01

    The current paper presented theoretical assumptions behind language learning strategies (LLS) and an overview of methods used to identify learners' strategies, first, and then summarized what have been reported from large number of descriptive studies of strategies by language learners. Moreover, the paper tried to present the variety of…

  12. Burnout Syndrome: Global Medicine Volunteering as a Possible Treatment Strategy.

    Science.gov (United States)

    Iserson, Kenneth V

    2018-04-01

    In the last few decades, "burnout syndrome" has become more common among clinicians, or at least more frequently recognized. Methods to prevent and treat burnout have had inconsistent results. Simultaneously, clinicians' interest in global medicine has increased dramatically, offering a possible intervention strategy for burnout while providing help to underserved areas. Caused by a variety of stressors, burnout syndrome ultimately results in physicians feeling that their work no longer embodies why they entered the medical field. This attitude harms clinicians, their patients and colleagues, and society. Few consistently successful interventions exist. At the same time, clinicians' interest in global medicine has risen exponentially. This paper reviews the basics of both phenomena and posits that global medicine experiences, although greatly assisting target populations, also may offer a strategy for combating burnout by reconnecting physicians with their love of the profession. Because studies have shown that regular volunteering improves mental health, short-term global medicine experiences may reinvigorate and reengage clinicians on the verge of, or suffering from, persistent burnout syndrome. Fortuitously, this intervention often will greatly benefit medically underserved populations. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Tourette Syndrome and comorbid ADHD: current pharmacological treatment options.

    Science.gov (United States)

    Rizzo, Renata; Gulisano, Mariangela; Calì, Paola V; Curatolo, Paolo

    2013-09-01

    Attention Deficit Hyperactivity Disorder (ADHD) is the most common co-morbid condition encountered in people with tics and Tourette Syndrome (TS). The co-occurrence of TS and ADHD is associated with a higher psychopathological, social and academic impairment and the management may represent a challenge for the clinicians. To review recent advances in management of patients with tic, Tourette Syndrome and comorbid Attention Deficit Hyperactivity Disorder. We searched peer reviewed and original medical publications (PUBMED 1990-2012) and included randomized, double-blind, controlled trials related to pharmacological treatment for tic and TS used in children and adolescents with comorbid ADHD. "Tourette Syndrome" or "Tic" and "ADHD", were cross referenced with the words "pharmacological treatment", "α-agonist", "psychostimulants", "selective norepinephrine reuptake inhibitor", "antipsychotics". Three classes of drugs are currently used in the treatment of TS and comorbid ADHD: α-agonists (clonidine and guanfacine), stimulants (amphetamine enantiomers, methylphenidate enantiomers or slow release preparation), and selective norepinephrine reuptake inhibitor (atomoxetine). It has been recently suggested that in a few selected cases partial dopamine agonists (aripiprazole) could be useful. Level A of evidence supported the use of noradrenergic agents (clonidine). Reuptake inhibitors (atomoxetine) and stimulants (methylphenidate) could be, also used for the treatment of TS and comorbid ADHD. Taking into account the risk-benefit profile, clonidine could be used as the first line treatment. However only few studies meet rigorous quality criteria in terms of study design and methodology; most trials have low statistical power due to small sample size or short duration. Treatment should be "symptom targeted" and personalized for each patient. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  14. Gender differences in outcomes in patients with acute coronary syndrome in the current era: A review.

    Science.gov (United States)

    Tan, Ying C; Sinclair, Hannah; Ghoorah, Kuldeepa; Teoh, Xuyan; Mehran, Roxana; Kunadian, Vijay

    2016-11-01

    Coronary heart disease is the most common cause of death worldwide. In the United Kingdom in 2010, over 80,000 deaths were attributed to coronary heart disease, and one in 10 female deaths were due to coronary heart disease. Acute coronary syndrome, a subset of coronary heart disease, was responsible for 175,000 inpatient admissions in the United Kingdom in 2012. While men have traditionally been considered to be at higher risk of acute coronary syndrome, various studies have demonstrated that women often suffer from poorer outcomes following an adverse cardiovascular event. This gap is gradually narrowing with the introduction of advanced interventional strategies and pharmacotherapy. However, a better understanding of these differences is of crucial importance for the improvement of the pharmacological and interventional management of acute coronary syndrome and for the development of possible new gender-specific diagnostic and therapeutic options. The goals of this review are to evaluate gender differences in outcomes in patients with acute coronary syndrome in the current era and identify potential mechanisms behind these differences in outcomes following percutaneous coronary intervention.

  15. Complications and challenges associated with polycystic ovary syndrome: current perspectives.

    Science.gov (United States)

    Palomba, Stefano; Santagni, Susanna; Falbo, Angela; La Sala, Giovanni Battista

    2015-01-01

    Polycystic ovary syndrome (PCOS) represents the most common endocrine dysfunction in fertile women and it is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome's risks. Women with PCOS present an adverse reproductive profile, including a high risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes mellitus. Patients with PCOS present not only a higher prevalence of classic cardiovascular risk factors, such as hypertension, dyslipidemia, and type-2 diabetes mellitus, but also of nonclassic cardiovascular risk factors, including mood disorders, such as depression and anxiety. Moreover, at the moment, clinical data on cardiovascular morbidity and mortality in women with PCOS are controversial. Finally, women with PCOS show an increased risk of endometrial cancer compared to non-PCOS healthy women, particularly during premenopausal period. Currently, we are unable to clarify if the increased PCOS early- and long-term risks are totally due to PCOS per se or mostly due to obesity, in particular visceral obesity, that characterized the majority of PCOS patients. In any case, the main endocrine and gynecological scientific societies agree to consider women with PCOS at increased risk of obstetric, cardiometabolic, oncology, and psychological complications throughout life, and it is recommended that these women be accurately assessed with periodic follow-up.

  16. Current best practice in the management of Turner syndrome

    Science.gov (United States)

    Shankar, Roopa Kanakatti; Backeljauw, Philippe F.

    2017-01-01

    Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population. PMID:29344338

  17. Discrete Current Control Strategy of Permanent Magnet Synchronous Motors

    Directory of Open Access Journals (Sweden)

    Yan Dong

    2013-01-01

    Full Text Available A control strategy of permanent magnet synchronous motors (PMSMs, which is different from the traditional vector control (VC and direct torque control (DTC, is proposed. Firstly, the circular rotating magnetic field is analyzed on the simplified model and discredited into stepping magnetic field. The stepping magnetomotive force will drive the rotor to run as the stepping motor. Secondly, the stator current orientation is used to build the control model instead of rotor flux orientation. Then, the discrete current control strategy is set and adopted in positioning control. Three methods of the strategy are simulated in computer and tested on the experiment platform of PMSM. The control precision is also verified through the experiment.

  18. [Cotard's syndrome. Different treatment strategies according to subclassification].

    Science.gov (United States)

    Madani, Y; Sabbe, B G C

    2007-01-01

    After performing an exploratory factor analysis, Berrios & Luque (1995) identified three subcategories in the Cotard's syndrome: Cotard type I, Cotard type II and Cotard type psychotic depression. The article, which is based on two case studies and an examination of the relevant literature since 1995, explores whether there are different treatment strategies for Cotard type I and the Cotard type psychotic depression. For the Cotard type psychotic depression, electroconvulsive therapy proves to be an effective method of treatment. For Cotard type I, antipsychotic therapy seems to be sufficient.

  19. Current collective engagement stakeholder strategies for South African labour relations

    Directory of Open Access Journals (Sweden)

    Popi C. Madlala

    2018-05-01

    Full Text Available Orientation: Collective engagement stakeholder strategies are significant for the creation of harmony in the workplace. It is a known fact that the South African (SA labour environment has been dominated by industrial action before and after the 1994 democratic transition. To be precise, the statistics reveals that industrial action has increased and become more destructive post-1994. Purpose: The purpose of this article was to present the current collective engagement stakeholder strategies for South African labour relations. Motivation for the study: The SA mining sector has seen more violent strikes, with a higher number of deaths, injuries, criminal activities, arrests, dismissals and job losses in recent years. This article captures the current mining stakeholder strategies shaping the existing labour relations environment. Research approach, design and method: This is a theoretical article highlighting the recent literature on collective engagement in the mining sector in South Africa. Main findings: This article presents the current labour relations incidents, reflecting the need for more effective collective engagement and stakeholder management strategies. Practical and managerial implications: The current labour relations context has prompted key stakeholders at the National Economic Development and Labour Council (NEDLAC to look specifically at promoting employment, labour market stability, the right to strike, minimising violence through collective bargaining and highlighting the role of the state, reducing vulnerability through social protection and increasing the minimum wage. Contribution or value add: This article adds theoretically to the existing body of knowledge regarding collective engagement and stakeholder strategies in the SA mining sector.

  20. Complications and challenges associated with polycystic ovary syndrome: current perspectives

    Directory of Open Access Journals (Sweden)

    Palomba S

    2015-07-01

    Full Text Available Stefano Palomba,1 Susanna Santagni,1 Angela Falbo,1 Giovanni Battista La Sala1,21Unit of Obstetrics and Gynecology, Arcispedale Santa Maria Nuova-Scientific Institute of Treatment and Care (IRCCS, Reggio Emilia, 2Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Modena, ItalyAbstract: Polycystic ovary syndrome (PCOS represents the most common endocrine dysfunction in fertile women and it is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome’s risks. Women with PCOS present an adverse reproductive profile, including a high risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes mellitus. Patients with PCOS present not only a higher prevalence of classic cardiovascular risk factors, such as hypertension, dyslipidemia, and type-2 diabetes mellitus, but also of nonclassic cardiovascular risk factors, including mood disorders, such as depression and anxiety. Moreover, at the moment, clinical data on cardiovascular morbidity and mortality in women with PCOS are controversial. Finally, women with PCOS show an increased risk of endometrial cancer compared to non-PCOS healthy women, particularly during premenopausal period. Currently, we are unable to clarify if the increased PCOS early- and long-term risks are totally due to PCOS per se or mostly due to obesity, in particular visceral obesity, that characterized the majority of PCOS patients. In any case, the main endocrine and gynecological scientific societies agree to consider women with PCOS at increased risk of obstetric, cardiometabolic, oncology, and psychological complications throughout life, and it is recommended that these women be accurately assessed with periodic follow-up.Keywords: cardiovascular disease, infertility, polycystic ovary syndrome, PCOS, pregnancy

  1. Neurosurgical strategies for Gilles de la Tourette’s syndrome

    Directory of Open Access Journals (Sweden)

    Karim Mukhida

    2008-09-01

    Full Text Available Karim Mukhida1,2, Matthew Bishop2, Murray Hong2, Ivar Mendez21Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; 2Departments, of Anatomy and Neurobiology and Surgery (Neurosurgery, Dalhousie University, Halifax, Nova Scotia, CanadaAbstract: Tourette’s syndrome (TS is a neurological disorder characterized by motor and vocal tics that typically begin in childhood and often are accompanied by psychiatric comorbidities. Symptoms of TS may be socially disabling and cause secondary medical complications. Pharmacological therapies remain the mainstay of symptom management. For the subset of patients in whom TS symptoms are medically recalcitrant and do not dissipate by adulthood, neurosurgery may offer an alternative treatment strategy. Greater understanding of the neuroanatomic and pathophysiologic basis of TS has facilitated the development of surgical procedures that aim to ameliorate TS symptoms by lesions or deep brain stimulation of cerebral structures. Herein, the rationale for the surgical management of TS is discussed and neurosurgical experiences since the 1960s are reviewed. The necessity for neurosurgical strategies to be performed with appropriate ethical considerations is highlighted.Keywords: tourette’s syndrome, neurosurgery, deep brain stimulation, thalamus

  2. Cuba's Strategy for Alzheimer Disease and Dementia Syndromes.

    Science.gov (United States)

    Bosch-Bayard, Rodolfo I; Llibre-Rodríguez, Juan J; Fernández-Seco, Alberto; Borrego-Calzadilla, Carmen; Carrasco-García, Mayra R; Zayas-Llerena, Tania; Moreno-Carbonell, Carmen R; Reymond-Vasconcelos, Ana G

    2016-10-01

    Dementia is a great challenge to public health in Cuba due to its impact on society and families. Cuba's National Intervention Strategy for Alzheimer Disease and Dementia Syndromes is designed to address this challenge. The Strategy includes working guidelines for primary and secondary care, education about rights of people with cognitive impairment, professional development, research, and health promotion and dementia prevention. An associated action plan, focused on primary care, includes proposals for creation of memory clinics, day centers and comprehensive rehabilitation services for cognitive stimulation. Short-term measures proposed include increasing early detection; creating a dementia morbidity and mortality registry; promoting professional training; providing support for families; and promoting basic and clinical research on dementia. Medium-term proposals aim to reduce dementia incidence and mortality by controlling risk factors and promoting healthy lifestyles, offering new treatment options and optimizing early detection. A set of indicators has been developed to evaluate strategy implementation. With this strategy, Cuba joins the small number of developing countries that have responded to WHO's call to improve care for patients with dementia and alleviate its impact on society and families. KEYWORDS Dementia, Alzheimer disease, aging, national health programs, social stigma, primary prevention, health promotion, civil rights, Cuba.

  3. Part 2 -- current program integrating strategies and lubrication technology

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, B.

    1996-12-01

    This paper is the second of two that describe the Predictive Maintenance Program for rotating machinery at the Palo Verde Nuclear Generating Station. The Predictive Maintenance program has been enhanced through organizational changes and improved interdisciplinary usage of technology. This paper will discuss current program strategies that have improved the interaction between the Vibration and Lube Oil programs. The {open_quotes}Lube Oil{close_quotes} view of the combined program along with case studies will then be presented.

  4. Part 2 -- current program integrating strategies and lubrication technology

    International Nuclear Information System (INIS)

    Johnson, B.

    1996-01-01

    This paper is the second of two that describe the Predictive Maintenance Program for rotating machinery at the Palo Verde Nuclear Generating Station. The Predictive Maintenance program has been enhanced through organizational changes and improved interdisciplinary usage of technology. This paper will discuss current program strategies that have improved the interaction between the Vibration and Lube Oil programs. The open-quotes Lube Oilclose quotes view of the combined program along with case studies will then be presented

  5. Current and emerging somatic treatment strategies in psychotic major depression.

    Science.gov (United States)

    Dannon, Pinhas N; Lowengrub, Katherine; Gonopolski, Yehudit; Kotler, Moshe

    2006-01-01

    Psychotic major depressive disorder (MDD) is a mood disorder characterized by severe affective and neurovegetative symptoms together with the presence of delusions and/or hallucinations. It is a common disorder seen in a quarter of consecutively admitted depressed patients and is often associated with severe symptomatology, increased suicide risk, poor acute response to antidepressants and poor acute and long-term treatment outcome. It is possible that poor response in psychotic depression is caused by the fact that we have yet to identify the most efficacious treatment protocol for psychotic MDD. Multiple studies have shown that modifications in the treatment paradigm may increase treatment efficacy in psychotic MDD. It has been generally accepted that, during the acute treatment phase, antidepressant-antipsychotic drug combination therapy is more effective than either treatment alone, although this strategy has recently been challenged. The question of the optimal duration of pharmacotherapy in order to prevent relapse and improve long-term (i.e., 5-year) outcome is a focus of current investigation. This article will review currently recommended treatment strategies for the acute, continuation and maintenance phases of therapy. In particular, it will address the role of newer-generation antidepressants, the role of second-generation antipsychotics, the use of mood stabilizers and indications for electroconvulsive therapy. Other possible treatment strategies such as transcranial magnetic stimulation, vagus nerve stimulation, deep-brain stimulation and glucocorticoid receptor antagonists will be discussed. Current recommendations for the prevention of relapse and improvement of long-term outcome will be reviewed.

  6. Complications and challenges associated with polycystic ovary syndrome: current perspectives

    Science.gov (United States)

    Palomba, Stefano; Santagni, Susanna; Falbo, Angela; La Sala, Giovanni Battista

    2015-01-01

    Polycystic ovary syndrome (PCOS) represents the most common endocrine dysfunction in fertile women and it is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome’s risks. Women with PCOS present an adverse reproductive profile, including a high risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes mellitus. Patients with PCOS present not only a higher prevalence of classic cardiovascular risk factors, such as hypertension, dyslipidemia, and type-2 diabetes mellitus, but also of nonclassic cardiovascular risk factors, including mood disorders, such as depression and anxiety. Moreover, at the moment, clinical data on cardiovascular morbidity and mortality in women with PCOS are controversial. Finally, women with PCOS show an increased risk of endometrial cancer compared to non-PCOS healthy women, particularly during premenopausal period. Currently, we are unable to clarify if the increased PCOS early- and long-term risks are totally due to PCOS per se or mostly due to obesity, in particular visceral obesity, that characterized the majority of PCOS patients. In any case, the main endocrine and gynecological scientific societies agree to consider women with PCOS at increased risk of obstetric, cardiometabolic, oncology, and psychological complications throughout life, and it is recommended that these women be accurately assessed with periodic follow-up. PMID:26261426

  7. Fragile X syndrome: Current insight | Dean | Egyptian Journal of ...

    African Journals Online (AJOL)

    Fragile X syndrome (FXS) is a multigenerational disorder having massive adverse effect not only on the individuals but also on their families. It is the most common type of intellectual disability after Down's syndrome. Over two decades have passed since the discovery of FMR1, the causal gene for FXS, but still little is known ...

  8. CMS Data Analysis: Current Status and Future Strategy

    CERN Document Server

    Innocente, V

    2003-01-01

    We present the current status of CMS data analysis architecture and describe work on future Grid-based distributed analysis prototypes. CMS has two main software frameworks related to data analysis: COBRA, the main framework, and IGUANA, the interactive visualisation framework. Software using these frameworks is used today in the world-wide production and analysis of CMS data. We describe their overall design and present examples of their current use with emphasis on interactive analysis. CMS is currently developing remote analysis prototypes, including one based on Clarens, a Grid-enabled client-server tool. Use of the prototypes by CMS physicists will guide us in forming a Grid-enriched analysis strategy. The status of this work is presented, as is an outline of how we plan to leverage the power of our existing frameworks in the migration of CMS software to the Grid.

  9. Novel strategies in the management of polycystic ovary syndrome.

    Science.gov (United States)

    Spritzer, P M; Motta, A B; Sir-Petermann, T; Diamanti-Kandarakis, E

    2015-09-01

    Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting reproductive-aged women. PCOS has been recognized as a syndrome combining reproductive and metabolic abnormalities with lifelong health implications. Cardiometabolic alterations require regular screening and effective and targeted lifestyle advice to lose weight as well as to prevent weight gain. Pharmacological therapy includes insulin-sensitizer drugs and agents that act directly on metabolic comorbidities, such as statins and antiobesity drugs. Bariatric surgery may be an option for severely obese women with PCOS Regarding reproductive aspects, ovulation induction with antiestrogens such as clomiphene citrate or letrozole is the first-line medical treatment. Exogenous gonadotropins and in vitro fertilization (IVF) are recommended as second-line treatment for anovulatory infertility. Laparoscopic ovarian diathermy may be used in special cases and metformin is no longer recommended for ovulation induction. Combined oral contraceptives (OCs) are the first-line treatment for the management of menstrual irregularities in women not seeking pregnancy, also providing endometrial protection and contraception. Progestin-only pills or cyclical progestins are recommended for those with contraindications to OCs. Metformin is also considered a second-line choice for improving menstrual cycles in women presenting insulin-resistance and dysglicemia. Hirsutism requires cosmetic procedures and medical treatment with OCs. More severe cases may need anti-androgen drugs added to the OCs. In conclusion, strategies regarding the management of reproductive issues in PCOS encompass a tailored approach to individual needs of each patient.

  10. Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

    Directory of Open Access Journals (Sweden)

    Vargas-Pérez NJ

    2017-05-01

    bulk of the evidence favors such an association. Conclusion: The current evidence in general supports the association between RLS/PLMS and CVD. The variability of results likely represent differences in study designs, RLS criteria used, RLS severity, duration of disease, and time of follow-up between the studies. As the association between RLS/PLMS and CVD is not definitive at this time, further suggested studies are outlined. Keywords: restless legs syndrome, periodic limb movements in sleep, cardiovascular disease, heart disease, hypertension, stroke, chronic kidney disease

  11. Current status of RCA projects and strategies for future implementation

    International Nuclear Information System (INIS)

    Kim, Kyoung Pyo; Lee, Jeong Kong

    1998-12-01

    This report is intended to provide basic overall information about ways to promote technical cooperation within the framework of RCA to accelerate and coordinate cooperative activities in nuclear science and technology in Asia and the Pacific region through a thorough review on the current status and through suggesting future implementation strategies. The contents of this report include an overall introduction of RCA, guidelines and operating rules for RCA programmes, current status and future plans for RCA projects as well as the RCA vision for the next 25 years. By reviewing the current status and future implementation strategies for RCA projects, it will help to set up a national nuclear policy aimed at seeking maximum benefits from participation in RCA projects and to implement programmes for nuclear cooperation with Asian-Pacific countries. It is expected that as a lead country for the energy sector, which is one of five thematic areas for the year 1999 - 2000 cycle programmes, Korea will continue to make significant contributions towards the implementation of RCA programmes in the future. With this report, we plan to keep up with future developments as well as implement an effective cooperation with the countries in the region so that the opinion of Korea, one of the nuclear advanced countries in the region, can be fully reflected in the establishment of future plans for RCA programmes. (author). 3 refs., 5 tabs., 1 fig

  12. Etiology and pathogenesis of the Marfan syndrome: current understanding.

    Science.gov (United States)

    Pyeritz, Reed E

    2017-11-01

    Much has changed regarding Marfan syndrome (MFS) over the past few decades. Once described solely as a heritable disorder of connective tissue, MFS is now one of a number of conditions recognized to be a disorder of abnormal signalling in the TGF-β pathway. The cardinal features of MFS, once encompassed by the ocular, skeletal and cardiovascular systems, are now known to encompass many more organ systems, especially as people with MFS grow older. They are growing older by several decades compared to the 1970's because of profound improvements in diagnosis and management of the cardiovascular features, especially dilatation of the aortic root. This dilatation can be detected first in infancy and followed up by echocardiography. Progressive enlargement increases the risk of type A dissection and aortic regurgitation, the major causes of early mortality, in untreated patients today. Medical therapy with β-adrenergic blockade, first shown to be effective in the 1980's, can retard this dilatation. In the past decade, angiotensin receptor blockade, which reduces aberrant signalling through one of the TGF-β pathways, also can be effective. However, when dilatation of the root becomes such that the risk of dissection increases to an unacceptable degree, surgical therapy becomes necessary. In the mid-1970's, the composite graft, introduced by Hugh Bentall, markedly reduced mortality. In the past decade, a valve-spring aortic root replacement, advanced by Tirone David, has become widely adopted. Mid-term results are quite encouraging. Other cardiovascular involvement, such as mitral valve prolapse, type B dissection, and dilatation and dissection of aortic branches, also require close monitoring. Currently, life-expectancy in people with MFS who are diagnosed early and treated prophylactically is approaching that of the general population.

  13. Valuable metals - recovery processes, current trends, and recycling strategies

    Energy Technology Data Exchange (ETDEWEB)

    Froehlich, Peter; Lorenz, Tom; Martin, Gunther; Brett, Beate; Bertau, Martin [Institut fuer Technische Chemie, TU Bergakademie Freiberg, Leipziger Strasse 29, 09599, Freiberg (Germany)

    2017-03-01

    This Review provides an overview of valuable metals, the supply of which has been classified as critical for Europe. Starting with a description of the current state of the art, novel approaches for their recovery from primary resources are presented as well as recycling processes. The focus lies on developments since 2005. Chemistry strategies which are used in metal recovery are summarized on the basis of the individual types of deposit and mineral. In addition, the economic importance as well as utilization of the metals is outlined. (copyright 2017 Wiley-VCH Verlag GmbH and Co. KGaA, Weinheim)

  14. Strategies to Identify the Lynch Syndrome Among Patients With Colorectal Cancer

    Science.gov (United States)

    Ladabaum, Uri; Wang, Grace; Terdiman, Jonathan; Blanco, Amie; Kuppermann, Miriam; Boland, C. Richard; Ford, James; Elkin, Elena; Phillips, Kathryn A.

    2013-01-01

    Background Testing has been advocated for all persons with newly diagnosed colorectal cancer to identify families with the Lynch syndrome, an autosomal dominant cancer-predisposition syndrome that is a paradigm for personalized medicine. Objective To estimate the effectiveness and cost-effectiveness of strategies to identify the Lynch syndrome, with attention to sex, age at screening, and differential effects for probands and relatives. Design Markov model that incorporated risk for colorectal, endometrial, and ovarian cancers. Data Sources Published literature. Target Population All persons with newly diagnosed colorectal cancer and their relatives. Time Horizon Lifetime. Perspective Third-party payer. Intervention Strategies based on clinical criteria, prediction algorithms, tumor testing, or up-front germline mutation testing, followed by tailored screening and risk-reducing surgery. Outcome Measures Life-years, cancer cases and deaths, costs, and incremental cost-effectiveness ratios. Results of Base-Case Analysis The benefit of all strategies accrued primarily to relatives with a mutation associated with the Lynch syndrome, particularly women, whose life expectancy could increase by approximately 4 years with hysterectomy and salpingo-oophorectomy and adherence to colorectal cancer screening recommendations. At current rates of germline testing, screening, and prophylactic surgery, the strategies reduced deaths from colorectal cancer by 7% to 42% and deaths from endometrial and ovarian cancer by 1% to 6%. Among tumor-testing strategies, immunohistochemistry followed by BRAF mutation testing was preferred, with an incremental cost-effectiveness ratio of $36 200 per life-year gained. Results of Sensitivity Analysis The number of relatives tested per proband was a critical determinant of both effectiveness and cost-effectiveness, with testing of 3 to 4 relatives required for most strategies to meet a threshold of $50 000 per life-year gained. Immunohistochemistry

  15. Management strategies for premenstrual syndrome/premenstrual dysphoric disorder.

    Science.gov (United States)

    Jarvis, Courtney I; Lynch, Ann M; Morin, Anna K

    2008-07-01

    To evaluate the current nonpharmacologic and pharmacologic treatment options for symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Literature was obtained through searches of MEDLINE Ovid (1950-March week 3, 2008) and EMBASE Drugs and Pharmacology (all years), as well as a bibliographic review of articles identified by the searches. Key terms included premenstrual syndrome, premenstrual dysphoric disorder, PMS, PMDD, and treatment. All pertinent clinical trials, retrospective studies, and case reports in human subjects published in the English language were identified and evaluated for the safety and efficacy of pharmacologic and nonpharmacologic treatments of PMS/PMDD. Data from these studies and information from review articles were included in this review. Selective serotonin-reuptake inhibitors (SSRIs) have been proven safe and effective for the treatment of PMDD and are recommended as first-line agents when pharmacotherapy is warranted. Currently fluoxetine, controlled-release paroxetine, and sertraline are the only Food and Drug Administration-approved agents for this indication. Suppression of ovulation using hormonal therapies is an alternative approach to treating PMDD when SSRIs or second-line psychotropic agents are ineffective; however, adverse effects limit their use. Anxiolytics, spironolactone, and nonsteroidal antiinflammatory drugs can be used as supportive care to relieve symptoms. Despite lack of specific evidence, lifestyle modifications and exercise are first-line recommendations for all women with PMS/PMDD and may be all that is needed to treat mild-to-moderate symptoms. Herbal and vitamin supplementation and complementary and alternative medicine have been evaluated for use in PMS/PMDD and have produced unclear or conflicting results. More controlled clinical trials are needed to determine their safety and efficacy and potential for drug interactions. Healthcare providers need to be aware of the symptoms of

  16. [Current issues on irritable bowel syndrome: diet and irritable bowel syndrome].

    Science.gov (United States)

    Kim, Jeong Hwan; Sung, In-Kyung

    2014-09-25

    Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multifactorial disorder with its pathogenesis attributed to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, communication in the gut-brain axis, and so on. Traditionally, IBS has been treated with diet and lifestyle modification, fiber supplementation, psychological therapy, and pharmacological treatment. Carbohydrates are intermingled with a wide range of regularly consumed food including grains such as rye and wheat, vegetables, fruits, and legumes. Short-chain carbohydrates that are poorly absorbed exert osmotic effects in the intestinal lumen increasing its water volume, and are rapidly fermented by bacteria with consequent gas production. These effects may be the basis for the induction of most of the gastrointestinal symptoms. This has led to the use of lactose-free diets in those with lactose intolerance and of fructose-reduced diets for fructose malabsorption. As all poorly absorbed short-chain carbohydrates have similar and additive effects in the intestine, a concept has been developed to regard them collectively as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and to evaluate a dietary approach that restricts them all. Based on the observational and comparative studies, and randomized-controlled trials, FODMAPs have been shown to trigger gastrointestinal symptoms in patients with IBS. Food choice via the low FODMAPs and potentially other dietary strategies is now a realistic and efficacious therapeutic approach for managing symptoms of IBS.

  17. Serotonin syndrome:case report and current concepts.

    LENUS (Irish Health Repository)

    Fennell, J

    2005-05-01

    Selective serotonin reuptake inhibitors (SSRI\\'s) are increasingly being used as the first line therapeutic agent for the depression. It is therefore not unusual to see a case of overdose with these agents. More commonly an adverse drug reaction may be seen among the older patients who are particularly vulnerable to the serotonin syndrome due to multiple co-morbidity and polypharmacy. The clinical picture of serotonin syndrome (SS) is non-specific and there is no confirmatory test. SS may go unrecognized because it is often mistaken for a viral illness, anxiety, neurological disorder or worsening psychiatric condition.

  18. Keeping Current. Using BDA Strategies in the Library Media Center

    Science.gov (United States)

    Keller, Cynthia A.

    2005-01-01

    This article discusses BDA strategies--reading strategies that "good readers" use before, during, and after reading. These strategies are in conjunction with free reading as well as direct reading instruction by reading specialists and/or teachers. An explanation of "Before Reading Strategies," "During Reading Strategies," and "After Reading…

  19. Current and Future Challenges in Primary Sjogren's Syndrome

    NARCIS (Netherlands)

    Vissink, Arjan; Bootsma, Hendrika; Spijkervet, Fred K. L.; Hu, Shen; Wong, David T.; Kallenberg, Cees G. M.

    Sjogren's syndrome (SS) is an autoimmune inflammatory disorder of exocrine glands. SS particularly affects the lacrimal and salivary glands. Dry mouth and dry eyes are frequently proffered as presenting symptoms, but nonspecific symptoms such as malaise and fatigue, and extraglandular manifestations

  20. Supporting Students with Asperger Syndrome on College Campuses: Current Practices

    Science.gov (United States)

    Barnhill, Gena P.

    2016-01-01

    With the increasing number of students with Asperger syndrome (AS) and high functioning autism (HFA) enrolling in college, it has become apparent that support services are greatly needed to assist these students in navigating college life, both academically and socially. Yet, there is a dearth of research describing the specific supports needed…

  1. Stereotactic body radiotherapy: current strategies and future development

    Science.gov (United States)

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  2. Steam generator degradation: Current mitigation strategies for controlling corrosion

    International Nuclear Information System (INIS)

    Millett, P.

    1997-01-01

    Steam Generator degradation has caused substantial losses of power generation, resulted in large repair and maintenance costs, and contributed to significant personnel radiation exposures in Pressurized Water Reactors (PWRs) operating throughout the world. EPRI has just published the revised Steam Generator Reference Book, which reviews all of the major forms of SG degradation. This paper discusses the types of SG degradation that have been experienced with emphasis on the mitigation strategies that have been developed and implemented in the field. SG degradation is presented from a world wide perspective as all countries operating PWRs have been effected to one degree or another. The paper is written from a US. perspective where the utility industry is currently undergoing tremendous change as a result of deregulation of the electricity marketplace. Competitive pressures are causing utilities to strive to reduce Operations and Maintenance (O ampersand M) and capital costs. SG corrosion is a major contributor to the O ampersand M costs of PWR plants, and therefore US utilities are evaluating and implementing the most cost effective solutions to their corrosion problems. Mitigation strategies developed over the past few years reflect a trend towards plant specific solutions to SG corrosion problems. Since SG degradation is in most cases an economic problem and not a safety problem, utilities can focus their mitigation strategies on their unique financial situation. Accordingly, the focus of R ampersand D has shifted from the development of more expensive, prescriptive solutions (e.g. reduced impurity limits) to corrosion problems to providing the utilities with a number of cost effective mitigation options (e.g. molar ratio control, boric acid treatment)

  3. Osteoarthritis: detection, pathophysiology, and current/future treatment strategies.

    Science.gov (United States)

    Sovani, Sujata; Grogan, Shawn P

    2013-01-01

    Osteoarthritis (OA) is a disease of the joint, and age is the major risk factor for its development. Clinical manifestation of OA includes joint pain, stiffness, and loss of mobility. Currently, no pharmacological treatments are available to treat this specific joint disease; only symptom-modifying drugs are available. Improvement in imaging technology, identification of biomarkers, and increased understanding of the molecular basis of OA will aid in detecting the early stages of disease. Yet the development of interventional strategies remains elusive and will be critical for effective prevention of OA-associated joint destruction. The potential of cell-based therapies may be applicable in improving joint function in mild to more advanced cases of OA. Ongoing studies to understand the basis of this disease will eventually lead to prevention and treatment strategies and will also be a key in reducing the social and economic burden of this disease. Nurses are advised to provide an integrative approach of disease assessment and management in OA patients' care with a focus on education and implementation. Knowledge and understanding of OA and how this affects the individual patient form the basis for such an integrative approach to all-round patient care and disease management.

  4. Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

    Science.gov (United States)

    Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

    2017-01-01

    The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

  5. China's spent nuclear fuel management: Current practices and future strategies

    International Nuclear Information System (INIS)

    Zhou Yun

    2011-01-01

    Although China's nuclear power industry is relatively young and the management of its spent nuclear fuel is not yet a concern, China's commitment to nuclear energy and its rapid pace of development require detailed analyses of its future spent fuel management policies. The purpose of this study is to provide an overview of China's fuel cycle program and its reprocessing policy, and to suggest strategies for managing its future fuel cycle program. The study is broken into four sections. The first reviews China's current nuclear fuel cycle program and facilities. The second discusses China's current spent fuel management methods and the storage capability of China's 13 operational nuclear power plants. The third estimates China's total accumulated spent fuel, its required spent fuel storage from present day until 2035, when China expects its first commercialized fast neutron reactors to be operational, and its likely demand for uranium resources. The fourth examines several spent fuel management scenarios for the present period up until 2035; the financial cost and proliferation risk of each scenario is evaluated. The study concludes that China can and should maintain a reprocessing operation to meet its R and D activities before its fast reactor program is further developed. - Highlights: → This study provides an overview of China's fuel cycle program and its reprocessing policy.→ This study suggests strategies for managing its future fuel cycle program.→ China will experience no pressure to lessen the burden of spent fuel storage in the next 30 years.→ China should maintain sufficient reprocessing operations to meet its demands for R and D activities.→ China should actively invest on R and D activities of both fuel cycling and fast reactor programs.

  6. Lemierre’s syndrome: current perspectives on diagnosis and management

    Directory of Open Access Journals (Sweden)

    Johannesen KM

    2016-09-01

    Full Text Available Katrine M Johannesen,1 Uffe Bodtger1–3 1Department of Lung Medicine, Naestved Hospital, Naestved, 2Institute for Regional Health Research, University of Southern Denmark, Odense, 3Department of Pulmonology, Zealand University Hospital, Roskilde, Denmark Abstract: This is a systematic review of cases with Lemierre’s syndrome (LS in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician. Keywords: Lemierre’s syndrome

  7. Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

    Full Text Available Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its "culture-bound" status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.

  8. Current Hypotheses on How Microsatellite Instability Leads to Enhanced Survival of Lynch Syndrome Patients

    Directory of Open Access Journals (Sweden)

    Kristen M. Drescher

    2010-01-01

    Full Text Available High levels of microsatellite instability (MSI-high are a cardinal feature of colorectal tumors from patients with Lynch Syndrome. Other key characteristics of Lynch Syndrome are that these patients experience fewer metastases and have enhanced survival when compared to patients diagnosed with microsatellite stable (MSS colorectal cancer. Many of the characteristics associated with Lynch Syndrome including enhanced survival are also observed in patients with sporadic MSI-high colorectal cancer. In this review we will present the current state of knowledge regarding the mechanisms that are utilized by the host to control colorectal cancer in Lynch Syndrome and why these same mechanisms fail in MSS colorectal cancers.

  9. Current hypotheses on how microsatellite instability leads to enhanced survival of Lynch Syndrome patients.

    Science.gov (United States)

    Drescher, Kristen M; Sharma, Poonam; Lynch, Henry T

    2010-01-01

    High levels of microsatellite instability (MSI-high) are a cardinal feature of colorectal tumors from patients with Lynch Syndrome. Other key characteristics of Lynch Syndrome are that these patients experience fewer metastases and have enhanced survival when compared to patients diagnosed with microsatellite stable (MSS) colorectal cancer. Many of the characteristics associated with Lynch Syndrome including enhanced survival are also observed in patients with sporadic MSI-high colorectal cancer. In this review we will present the current state of knowledge regarding the mechanisms that are utilized by the host to control colorectal cancer in Lynch Syndrome and why these same mechanisms fail in MSS colorectal cancers.

  10. Gut microbiota role in irritable bowel syndrome: New therapeutic strategies.

    Science.gov (United States)

    Distrutti, Eleonora; Monaldi, Lorenzo; Ricci, Patrizia; Fiorucci, Stefano

    2016-02-21

    In the last decade the impressive expansion of our knowledge of the vast microbial community that resides in the human intestine, the gut microbiota, has provided support to the concept that a disturbed intestinal ecology might promote development and maintenance of symptoms in irritable bowel syndrome (IBS). As a correlate, manipulation of gut microbiota represents a new strategy for the treatment of this multifactorial disease. A number of attempts have been made to modulate the gut bacterial composition, following the idea that expansion of bacterial species considered as beneficial (Lactobacilli and Bifidobacteria) associated with the reduction of those considered harmful (Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) should attenuate IBS symptoms. In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation. Fecal transplant is an old treatment translated from the cure of intestinal infective pathologies that has recently gained a new life as therapeutic option for those patients with a disturbed gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.

  11. Oligometastatic non-small-cell lung cancer: current treatment strategies

    Directory of Open Access Journals (Sweden)

    Richard PJ

    2016-11-01

    Full Text Available Patrick J Richard, Ramesh Rengan Department of Radiation Oncology, University of Washington, Seattle, WA, USA Abstract: The oligometastatic disease theory was initially described in 1995 by Hellman and Weichselbaum. Since then, much work has been performed to investigate its existence in many solid tumors. This has led to subclassifications of stage IV cancer, which could redefine our treatment approaches and the therapeutic outcomes for this historically “incurable” entity. With a high incidence of stage IV disease, non-small-cell lung cancer (NSCLC remains a difficult cancer to treat and cure. Recent work has proven the existence of an oligometastatic state in NSCLC in terms of properly selecting patients who may benefit from aggressive therapy and experience long-term overall survival. This review discusses the current treatment approaches used in oligometastatic NSCLC and provides the evidence and rationale for each approach. The prognostic factors of many trials are discussed, which can be used to properly select patients for aggressive treatment regimens. Future advances in both molecular profiling of NSCLC to find targetable mutations and investigating patient selection may increase the number of patients diagnosed with oligometastatic NSCLC. As this disease entity increases, it is of utmost importance for oncologists treating NSCLC to be aware of the current treatment strategies that exist and the potential advantages/disadvantages of each. Keywords: oligometastatic, non-small-cell lung cancer, oligoprogressive, treatment

  12. Yellow Nail Syndrome: Report of Two Cases and a Brief Review of the Current Literature

    Directory of Open Access Journals (Sweden)

    Eunice Silva Oliveira

    2015-12-01

    We present two cases of undiagnosed YNS until the current admissions, despite several years of investigation. The authors wish to draw attention to this syndrome, of which diagnosis is clinical and of exclusion.

  13. Current aspects of polycystic ovary syndrome: A literature review

    Directory of Open Access Journals (Sweden)

    VICTOR HUGO LOPES DE ANDRADE

    Full Text Available SUMMARY Polycystic ovary syndrome (PCOS is a heterogeneous endocrine disorder with variable prevalence, affecting about one in every 15 women worldwide. The diagnosis of polycystic ovary syndrome requires at least two of the following criteria: oligoovulation and/or anovulation, clinical and/or biochemical evidence of hyperandrogenism and morphology of polycystic ovaries. Women with PCOS appear to have a higher risk of developing metabolic disorders, hypertension and cardiovascular disorders. The aim of this article was to present a review of the literature by searching the databases Pubmed and Scielo, focusing on publications related to polycystic ovaries, including its pathogenesis, clinical manifestations, diagnosis and therapeutic aspects, as well as its association with cardiovascular and arterial hypertensive disorders.

  14. EFL Teachers' Perceptions of Strategy Deficiency Syndrome: A Grounded Theory Study

    Science.gov (United States)

    Ostovar-Namaghi, Seyyed Ali; Ahmadabadi-Tak, Bahareh

    2017-01-01

    Strategy-deficient language learners struggle to develop their language proficiency through limiting and inappropriate strategies. This study aims at exploring experienced teachers' perceptions of strategy deficiency syndrome among EFL learners. To this end, the perspectives of a purposive sample of experienced teachers teaching in private…

  15. Metabolic syndrome in the Mediterranean region: Current status

    OpenAIRE

    Panagiotis Anagnostis

    2012-01-01

    Metabolic syndrome (MetS) is a cluster of metabolic abnormalities including abdominal obesity, impaired fasting glucose, hypertension and dyslipidemia. It seems to affect about one-fourth to one-fifth of the Mediterranean population, and its prevalence increases with age, being similar for both sexes and depending on the region and the definition used, with the National Cholesterol Education Program-Adult Treatment Panel-III (NCEP-ATPIII) definition being the most effective in the identificat...

  16. Complications and challenges associated with polycystic ovary syndrome: current perspectives

    OpenAIRE

    Palomba, Stefano; Santagni, Susanna; Falbo, Angela; La Sala, Giovanni Battista

    2015-01-01

    Stefano Palomba,1 Susanna Santagni,1 Angela Falbo,1 Giovanni Battista La Sala1,21Unit of Obstetrics and Gynecology, Arcispedale Santa Maria Nuova-Scientific Institute of Treatment and Care (IRCCS), Reggio Emilia, 2Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Modena, ItalyAbstract: Polycystic ovary syndrome (PCOS) represents the most common endocrine dysfunction in fertile women and it is considered a heterogeneous and multifaceted disorder, with multiple re...

  17. Iron deficiency anemia and Plummer–Vinson syndrome: current insights

    Directory of Open Access Journals (Sweden)

    Goel A

    2017-10-01

    Full Text Available Amit Goel,1 Satvinder Singh Bakshi,2 Neetu Soni,3 Nanda Chhavi4 1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; 2Department of Otorhinolaryngology and Head and Neck Surgery, Mahatma Gandhi Medical College and Research Institute, Puducherry, India; 3Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; 4Department of Pediatrics, Era’s Lucknow Medical College, Lucknow, India Abstract: Plummer–Vinson syndrome (PVS, a rare clinical condition, is characterized by a triad of dysphagia, iron deficiency anemia and esophageal web in the post-cricoid region. It was first described over a century ago. However, literature on this condition remains scanty, and its prevalence appears to be declining worldwide, possibly due to improvements in nutrition over time. The condition has been reported most commonly in thin-built, middle-aged, white women. The esophageal webs in PVS are thin mucosal folds, which are best seen either in lateral views at barium swallow or at esophagoscopy. These are usually semilunar or crescentic, being located most often along the anterior esophageal wall, but can be concentric. The exact cause and pathogenesis of PVS remain unclear, though iron and other nutritional deficiencies, genetic predisposition and autoimmunity have all been implicated in formation of the webs. Treatment includes correction of iron deficiency and endoscopic dilation of the esophageal webs to relieve dysphagia. PVS is associated with an increased risk of hypopharyngeal and esophageal malignancies. Correction of iron deficiency may arrest and reverse the mucosal changes and possibly reduces this risk. Keywords: Plummer–Vinson syndrome, Paterson–Brown–Kelly syndrome, esophageal web, dysphagia, iron deficiency anemia

  18. Aortopathies in Turner syndrome -- new strategies for evaluation and treatment.

    Science.gov (United States)

    Kriksciuniene, Ruta; Ostrauskas, Rytas; Zilaitiene, Birute

    2015-01-01

    Turner syndrome is a rare genetic disorder which impairs women's growth, reproductive function, cardiovascular development and other functions. This syndrome has been proposed as an independent risk marker for cardiovascular disease. Despite this, life-threatening cardiovascular outcomes affecting young women are dismissed because of incomplete follow up. During assessment due to their smaller stature, it should be noted that, although the ascending aorta diameter is normal in absolute terms, after indexation for body size, patients with Turner syndrome may have a dilated aorta.Based on recent guidelines and the latest studies, there is new evidence on the use of magnetic resonance imaging in diagnosing aortic lesions. New management possibilities of aortopathies have also been discussed. This approach should optimise medical care for women with Turner syndrome, but many areas of uncertainty still remain in the diagnosis and management of this syndrome, and new prospective studies are needed.

  19. Current knowledge and treatment strategies for grade II gliomas

    International Nuclear Information System (INIS)

    Narita, Yoshitaka

    2013-01-01

    World Health Organization grade II gliomas (GIIGs) include diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma. GIIG is a malignant brain tumor for which the treatment outcome can still be improved. Review of previous clinical trials found the following: GIIG increased in size by 3-5 mm per year when observed or treated with surgery alone; after pathological diagnosis, the survival rate was increased by early aggressive tumor removal at an earlier stage compared to observation alone; although the prognosis after total tumor removal was significantly better than that after partial tumor removal, half of the patients relapsed within 5 years; comparing postoperative early radiotherapy (RT) and non-early RT after relapse, early RT prolonged progression-free survival (PFS) but did not affect overall survival (OS); local RT of 45 to 64.8 Gy did not impact PFS or OS; in patients with residual tumors, RT combined with chemotherapy (procarbazine plus lomustine plus vincristine) prolonged PFS compared with RT alone but did not affect OS; and poor prognostic factors included astrocytoma, non-total tumor removal, age ≥40 years, largest tumor diameter ≥4-6 cm, tumor crossing the midline, and neurological deficit. To improve treatment outcomes, surgery with functional brain mapping or intraoperative magnetic resonance imaging or chemoradiotherapy with temozolomide is important. In this review, current knowledge regarding GIIG is described and treatment strategies are explored. (author)

  20. Management strategies of enterovirus D68 outbreaks: current perspectives

    Directory of Open Access Journals (Sweden)

    Milhano N

    2018-03-01

    Full Text Available Natacha Milhano, Kaja Sverdrup Borge, Karoline Bragstad, Susanne G Dudman Domain for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway Abstract: Following its discovery in California in 1962, enterovirus D68 (EV-D68 was reported only sporadically around the world. In August 2014, a marked increase of EV-D68 cases in young children with severe respiratory infections was reported in the USA and Canada and later in Europe and Asia. Some of these cases were also found to be associated with acute flaccid paralysis, which exacerbated public health concern, and has since triggered international efforts to strengthen both EV-D68 and acute flaccid paralysis surveillance systems. This review summarizes the current knowledge on EV-D68, offering an overview of EV-D68 epidemiology, clinical presentations, diagnostic methodologies, and treatment strategies, as well as surveillance and outbreak management. Keywords: enterovirus D68, AFP, diagnostics, treatment, surveillance, outbreak 

  1. Current Research Therapeutic Strategies for Alzheimer’s Disease Treatment

    Directory of Open Access Journals (Sweden)

    Jaume Folch

    2016-01-01

    Full Text Available Alzheimer’s disease (AD currently presents one of the biggest healthcare issues in the developed countries. There is no effective treatment capable of slowing down disease progression. In recent years the main focus of research on novel pharmacotherapies was based on the amyloidogenic hypothesis of AD, which posits that the beta amyloid (Aβ peptide is chiefly responsible for cognitive impairment and neuronal death. The goal of such treatments is (a to reduce Aβ production through the inhibition of β and γ secretase enzymes and (b to promote dissolution of existing cerebral Aβ plaques. However, this approach has proven to be only modestly effective. Recent studies suggest an alternative strategy centred on the inhibition of the downstream Aβ signalling, particularly at the synapse. Aβ oligomers may cause aberrant N-methyl-D-aspartate receptor (NMDAR activation postsynaptically by forming complexes with the cell-surface prion protein (PrPC. PrPC is enriched at the neuronal postsynaptic density, where it interacts with Fyn tyrosine kinase. Fyn activation occurs when Aβ is bound to PrPC-Fyn complex. Fyn causes tyrosine phosphorylation of the NR2B subunit of metabotropic glutamate receptor 5 (mGluR5. Fyn kinase blockers masitinib and saracatinib have proven to be efficacious in treating AD symptoms in experimental mouse models of the disease.

  2. Sports-related concussions: diagnosis, complications, and current management strategies.

    Science.gov (United States)

    Hobbs, Jonathan G; Young, Jacob S; Bailes, Julian E

    2016-04-01

    Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

  3. Soil Contamination and Remediation Strategies. Current research and future challenge

    Science.gov (United States)

    Petruzzelli, G.

    2012-04-01

    eliminating the source of pollution, but also on blocking the pathways from contaminants to receptors or reducing the exposure to contaminants,. Future challenge integration of sustainability into remediation decision-making. Soil is not a waste! There is a growing interest in the clean up approaches that maintain soil quality after remediation treatments. This issue is of great importance in the U.S.A. where the EPA from 2009 is promoting innovative clean-up strategies (Green Remediation). Green remediation is defined as the practice of considering all environmental effects of remedy and incorporating options to maximize environmental benefit of cleanup actions . These remediation strategies restore contaminated sites to productive use with a great attention to the global environmental quality, including the preservation of soil functionality according to the following principles: use minimally invasive technologies; use passive energy technologies such as bioremediation and phytoremediation as primary remedies or finishing steps where possible and effective; minimize soil and habitat disturbance; minimize bioavailability of contaminants trough adequate contaminant source and plume control If we move from the current definition of remedial targets based on total concentrations, technologies with low impact on the environment can be utilized reducing the wrong choice to disposal soil in landfill destroying quickly a not renewable essential resource.

  4. Low Anterior Resection Syndrome: Current Management and Future Directions.

    Science.gov (United States)

    Ridolfi, Timothy J; Berger, Nicholas; Ludwig, Kirk A

    2016-09-01

    Outcomes for rectal cancer surgery have improved significantly over the past 20 years with increasing rates of survival and recurrence, specifically local recurrence. These gains have been realized during a period of time in which there has been an increasing emphasis on sphincter preservation. As we have become increasingly aggressive in avoiding resection of the anus, we have begun accepting bowel dysfunction as a normal outcome. Low anterior resection syndrome, defined as a constellation of symptoms including incontinence, frequency, urgency, or feelings of incomplete emptying, has a significant impact on quality of life and results in many patients opting for a permanent colostomy to avoid these symptoms. In this article, we will highlight the most recent clinical and basic science research on this topic and discuss areas of future investigation.

  5. Matrix metalloproteinases in acute coronary syndromes: current perspectives.

    Science.gov (United States)

    Kampoli, Anna-Maria; Tousoulis, Dimitris; Papageorgiou, Nikolaos; Antoniades, Charalambos; Androulakis, Emmanuel; Tsiamis, Eleftherios; Latsios, George; Stefanadis, Christodoulos

    2012-01-01

    Matrix metalloproteinases (MMPs) are a family of zinc metallo-endopeptidases secreted by cells and are responsible for much of the turnover of matrix components. Several studies have shown that MMPs are involved in all stages of the atherosclerotic process, from the initial lesion to plaque rupture. Recent evidence suggests that MMP activity may facilitate atherosclerosis, plaque destabilization, and platelet aggregation. In the heart, matrix metalloproteinases participate in vascular remodeling, plaque instability, and ventricular remodelling after cardiac injury. The aim of the present article is to review the structure, function, regulation of MMPs and to discuss their potential role in the pathogenesis of acute coronary syndromes, as well as their contribution and usefullness in the setting of the disease.

  6. Current and emerging treatment strategies for Duchenne muscular dystrophy

    Science.gov (United States)

    Mah, Jean K

    2016-01-01

    Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy in childhood. It is caused by mutations of the DMD gene, leading to progressive muscle weakness, loss of independent ambulation by early teens, and premature death due to cardiorespiratory complications. The diagnosis can usually be made after careful review of the history and examination of affected boys presenting with developmental delay, proximal weakness, and elevated serum creatine kinase, plus confirmation by muscle biopsy or genetic testing. Precise characterization of the DMD mutation is important for genetic counseling and individualized treatment. Current standard of care includes the use of corticosteroids to prolong ambulation and to delay the onset of secondary complications. Early use of cardioprotective agents, noninvasive positive pressure ventilation, and other supportive strategies has improved the life expectancy and health-related quality of life for many young adults with DMD. New emerging treatment includes viral-mediated microdystrophin gene replacement, exon skipping to restore the reading frame, and nonsense suppression therapy to allow translation and production of a modified dystrophin protein. Other potential therapeutic targets involve upregulation of compensatory proteins, reduction of the inflammatory cascade, and enhancement of muscle regeneration. So far, data from DMD clinical trials have shown limited success in delaying disease progression; unforeseen obstacles included immune response against the generated mini-dystrophin, inconsistent evidence of dystrophin production in muscle biopsies, and failure to demonstrate a significant improvement in the primary outcome measure, as defined by the 6-minute walk test in some studies. The long-term safety and efficacy of emerging treatments will depend on the selection of appropriate clinical end points and sensitive biomarkers to detect meaningful changes in disease progression. Correction of the underlying

  7. Current pharmacotherapeutic approaches for the treatment of Tourette syndrome.

    Science.gov (United States)

    Egolf, A; Coffey, B J

    2014-02-01

    Tourette syndrome is a childhood onset neurodevelopmental disorder characterized by multiple motor and vocal tics. Although many youth experience attenuation or even remission of tics in adolescence and young adulthood, some individuals experience persistent tics which can be debilitating or disabling. The majority of patients also have one or more psychiatric comorbid disorders, such as attention deficit hyperactivity disorder and/or obsessive-compulsive disorder. Treatment is multimodal, including both pharmacotherapy and cognitive behavioral treatment, and requires disentanglement of tics and the comorbid symptoms. Although the only two formally approved medications in the United States are haloperidol and pimozide, these treatments are generally not used as first-line interventions due to their significant potential for adverse effects. The α-adrenoceptor agonists guanfacine and clonidine have an established evidence base for both efficacy and tolerability, and are usually recommended as initial pharmacotherapy. Atypical neuroleptics, such as aripiprazole or risperidone, are typically used if the α-adrenoceptor agonists are ineffective or intolerable. However, many other pharmacological agents reviewed in this manuscript have been studied as treatment alternatives. Copyright 2014 Prous Science, S.A.U. or its licensors. All rights reserved.

  8. Sturge-Weber syndrome. The current neuro-imaging data

    International Nuclear Information System (INIS)

    Boukobza, M.; Cambra, M.R.; Merland, J.J.; Enjolras, O.

    2000-01-01

    Sturge-Weber syndrome (SWS) is a rare congenital sporadic disease with neuro-ocular and cutaneous vascular findings. Clinically, the full-blown condition consists of a facial port-wine stain (PWS) the V1 facial trigeminal skin area, alone or in combination with V2 and V3 PWS, seizures and ocular abnormalities (glaucoma and choroidal angioma). Radiologically, a leptomeningeal (pial) capillary and venous malformation, mostly located in the parieto-occipital area, cerebral atrophy and calcifications are demonstrated. An ipsilateral enlarged choroid plexus may be an early anatomic symptom. Development neuro-diagnostic technique for the screening of infants with an at-risk V1 PWS, as well as for the follow-up of patients with evidence SWS. Accelerated myelination in the involved hemisphere may be early diagnostic feature before 6 months of age. Later, hyperintensity of white matter on T2 is considered a symptom of gliosis. Clinically, progression of the diseases is associated with anatomic changes and correlates with the extent of the pial vascular anomaly, extent and severity of cerebral atrophy, and white matter abnormalities. A neonatal neuro-imaging work-up, using CT or MRI, may not demonstrate the pial anomaly and should be repeated after 6 to 12 months in an at-risk infant with V1 PWS. (authors)

  9. Zollinger-Ellison syndrome: classical considerations and current controversies.

    Science.gov (United States)

    Epelboym, Irene; Mazeh, Haggi

    2014-01-01

    Zollinger-Ellison syndrome (ZES) is an endocrinopathy characterized by gastrin-secreting tumors, responsible for causing the formation of multiple, refractory, and recurrent peptic ulcers in the distal duodenum and proximal jejunum. Two main variants have been described, sporadic and those found in association with parathyroid and pituitary tumors, a genetic disorder known as multiple endocrine neoplasia-1 (MEN-1). Biochemical serum evaluation for elevated gastrin, followed by radiological or nuclear localization of the primary lesion, is mandated for establishing diagnosis. The mainstays of treatment include management of hypersecretory state with medical suppression of gastric acid production and surgical resection of primary tumor for the prevention of malignant transformation and metastatic complications. Medical therapy with proton pump inhibitors has virtually eliminated the need for acid-reducing surgical procedures. Surgical approach to sporadic and MEN-1-associated ZES varies based on our understanding of the natural history of the condition and the probability of cure; however, resection to a negative microscopic margin is indicated in both cases. Postoperative surveillance involves measurement of gastrin level, followed by imaging if elevation is detected. Re-excision of recurrent or resection of metastatic disease is a subject of controversy; however, at the present time aggressive cytoreductive approach is favored.

  10. Strategies to Increase the Physical Activity Participation of Young Adults with Asperger Syndrome in Community Programs

    Science.gov (United States)

    Hamm, Jessica; Driver, Simon

    2015-01-01

    Currently one in 50 American school-age children is diagnosed with Autism. Although Asperger Syndrome is no longer acknowledged as a separate diagnosis, this article refers to high-functioning individuals with Autism as having Asperger Syndrome, since it is a culturally relevant term. One of the most challenging times for individuals with Asperger…

  11. Balanced Current Control Strategy for Current Source Rectifier Stage of Indirect Matrix Converter under Unbalanced Grid Voltage Conditions

    Directory of Open Access Journals (Sweden)

    Yeongsu Bak

    2016-12-01

    Full Text Available This paper proposes a balanced current control strategy for the current source rectifier (CSR stage of an indirect matrix converter (IMC under unbalanced grid voltage conditions. If the three-phase grid connected to the voltage source inverter (VSI of the IMC has unbalanced voltage conditions, it affects the currents of the CSR stage and VSI stage, and the currents are distorted. Above all, the distorted currents of the CSR stage cause instability in the overall system, which can affect the life span of the system. Therefore, in this paper, a control strategy for balanced currents in the CSR stage is proposed. To achieve balanced currents in the CSR stage, the VSI stage should receive DC power without ripple components from the CSR stage. This is implemented by controlling the currents in the VSI stage. Therefore, the proposed control strategy decouples the positive and negative phase-sequence components existing in the unbalanced voltages and currents of the VSI stage. Using the proposed control strategy under unbalanced grid voltage conditions, the stability and life span of the overall system can be improved. The effectiveness of the proposed control strategy is verified by simulation and experimental results.

  12. Improved control strategy for PI-R current of DFIG considering voltage and current harmonics compensation

    Science.gov (United States)

    Song, S. Y.; Liu, Q. H.; Zhao, Y. N.; Liu, S. Y.

    2016-08-01

    With the rapid development of wind power generation, the related research of wind power control and integration issues has attracted much attention, and the focus of the research are shifting away from the ideal power grid environment to the actual power grid environment. As the main stream wind turbine generator, a doubly-fed induction generator (DFIG) is connected to the power grid directly by its stator, so it is particularly sensitive to the power grid. This paper studies the improvement of DFIG control technology in the power grid harmonic environment. Based on the DFIG dynamic model considering the power grid harmonic environment, this paper introduces the shortcomings of the common control strategy of DFIG, and puts forward the enhanced method. The decoupling control of the system is realized by compensating the coupling between the rotor harmonic voltage and harmonic current, improving the control performance. In addition, the simulation experiments on PSCAD/EMTDC are carried out to verify the correctness and effectiveness of the improved scheme.

  13. The Gilles de la Tourette syndrome: the current status.

    Science.gov (United States)

    Robertson, Mary May

    2012-10-01

    Gilles de la Tourette syndrome (GTS) is characterised by multiple motor and one or more vocal/phonic tics. GTS was once thought to be rare, but many relatively recent studies suggest that the prevalence is about 1% of the worldwide community, apart from in Sub-Saharan Black Africa. Comorbidity and coexistent psychopathology are common, occurring in about 90% of clinical cohorts and individuals in the community. The most common comorbidities are attention deficit hyperactivity disorder, obsessive-compulsive behaviours, and disorder, and autistic spectrum disorders, while the most common coexisting psychopathologies are depression, anxiety and behavioural disorders such as oppositional defiant and conduct disorder. There has been an increasing amount of evidence to show that the quality of life in young people is reduced when compared with normative data or healthy control populations. It is widely accepted that most cases of GTS are inherited, but the genetic mechanisms appear much more complex than previously understood, as evidenced by many recent studies; indeed, there have been suggestions of 'general neurodevelopmental genes' which affect the brain development after which the 'specific GTS gene(s)' may further affect the phenotype. Other aetiopathogenetic suggestions have included environmental factors such as neuro-immunological factors, infections, prenatal and peri-natal difficulties and androgen influences. Few studies have addressed aetiology and phenotype, but initial results are exciting. The search for endophenotypes has followed subsequently. Intriguing neuroanatomical and brain circuitry abnormalities have now been suggested in GTS; the most evidence is for cortical thinning and a reduction in the size of the caudate nucleus. Thorough assessment is imperative and multidisciplinary management is the ideal. Treatment should be 'symptom targeted', and in mild cases, psycho-education and reassurance for the patient and the family may be sufficient

  14. Gait Strategy in Patients with Ehlers-Danlos Syndrome Hypermobility Type and Down Syndrome

    Science.gov (United States)

    Rigoldi, Chiara; Galli, Manuela; Cimolin, Veronica; Camerota, Filippo; Celletti, Claudia; Tenore, Nunzio; Albertini, Giorgio

    2012-01-01

    People suffering from Ehlers-Danlos syndrome (EDS) hypermobility type present a severe ligament laxity that results in difficulties in muscle force transmission. The same condition is present in people suffering from Down syndrome (DS) even if their clumsy movements are due to cerebral and cognitive impairments. The aim of this study was to…

  15. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management-An Insight into Future Approaches.

    Science.gov (United States)

    Chighizola, Cecilia Beatrice; Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control.

  16. Treatment of Thrombotic Antiphospholipid Syndrome: The Rationale of Current Management—An Insight into Future Approaches

    Science.gov (United States)

    Ubiali, Tania; Meroni, Pier Luigi

    2015-01-01

    Vascular thrombosis and pregnancy morbidity represent the clinical manifestations of antiphospholipid syndrome (APS), which is serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents currently provide the mainstay of APS treatment. However, the debate is still open: controversies involve the intensity and the duration of anticoagulation and the treatment of stroke and refractory cases. Unfortunately, the literature cannot provide definite answers to these controversial issues as it is flawed by many limitations, mainly due to the recruitment of patients not fulfilling laboratory and clinical criteria for APS. The recommended therapeutic management of different aPL-related clinical manifestations is hereby presented, with a critical appraisal of the evidence supporting such approaches. Cutting edge therapeutic strategies are also discussed, presenting the pioneer reports about the efficacy of novel pharmacological agents in APS. Thanks to a better understanding of aPL pathogenic mechanisms, new therapeutic targets will soon be explored. Much work is still to be done to unravel the most controversial issues about APS management: future studies are warranted to define the optimal management according to aPL risk profile and to assess the impact of a strict control of cardiovascular risk factors on disease control. PMID:26075289

  17. Companies on Facebook and Twitter. Current situation and communication strategies

    Directory of Open Access Journals (Sweden)

    JÁ Pérez Dasilva

    2013-10-01

    Full Text Available Introduction. Given their influence, companies are being forced to integrate social networks in their communication strategies. Objectives. This article aims to provide an overview of the use of Facebook and Twitter by the main commercial brands in Spain and to analyse the communication strategies of the companies that tend to receive more complaints from the public. Method. The study is based on the examination of the social network accounts of the three brands with the highest advertising investment in each of the 15 industry sectors. A total of 5,433 tweets and 3,000 posts were analysed. Conclusions. The study confirmed the massive presence of these companies is the social networks and demonstrated the extreme variability of the number of followers, the traffic and the nature of the information published. However, it was also demonstrated that the use made of the different social networks and the communication strategies required by the different companies are distinguishable and identifiable.

  18. Current Management Strategy for Active Surveillance in Prostate Cancer.

    Science.gov (United States)

    Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C

    2017-02-01

    Active surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes. Patient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30-50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer. The optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.

  19. Gastric tumours in hereditary cancer syndromes: clinical features, molecular biology and strategies for prevention.

    Science.gov (United States)

    Sereno, María; Aguayo, Cristina; Guillén Ponce, Carmen; Gómez-Raposo, César; Zambrana, Francisco; Gómez-López, Miriam; Casado, Enrique

    2011-09-01

    Gastric cancer is the major cause of cancer-related deaths worldwide. The majority of them are classified as sporadic, whereas the remaining 10% exhibit familial clustering. Hereditary diffuse gastric cancer (HDGC) syndrome is the most important condition that leads to hereditary gastric cancer. However, other hereditary cancer syndromes, such as hereditary non-polyposis colorectal cancer, familial adenomatous polyposis, Peutz-Jeghers syndrome, Li-Fraumeni syndrome and hereditary breast and ovarian cancer, entail a higher risk compared to the general population for developing this kind of neoplasia. In this review, we describe briefly the most important aspects related to clinical features, molecular biology and strategies for prevention in hereditary gastric associated to different cancer syndromes.

  20. Family Therapy of Terroristic Trauma: Psychological Syndromes and Treatment Strategies.

    Science.gov (United States)

    Miller, Laurence

    2003-01-01

    Reviews pertinent literature on terroristic trauma and combines this information with the author's experience in treating adults, children, and family victims and survivors of recent terrorist attacks. Describes the psychological syndromes resulting from terrorism and discusses the relevant individual and family therapy modalities for treating…

  1. Live porcine reproductive and respiratory syndrome virus vaccines: Current status and future direction.

    Science.gov (United States)

    Renukaradhya, Gourapura J; Meng, Xiang-Jin; Calvert, Jay G; Roof, Michael; Lager, Kelly M

    2015-08-07

    Porcine reproductive and respiratory syndrome (PRRS) caused by PRRS virus (PRRSV) was reported in the late 1980s. PRRS still is a huge economic concern to the global pig industry with a current annual loss estimated at one billion US dollars in North America alone. It has been 20 years since the first modified live-attenuated PRRSV vaccine (PRRSV-MLV) became commercially available. PRRSV-MLVs provide homologous protection and help in reducing shedding of heterologous viruses, but they do not completely protect pigs against heterologous field strains. There have been many advances in understanding the biology and ecology of PRRSV; however, the complexities of virus-host interaction and PRRSV vaccinology are not yet completely understood leaving a significant gap for improving breadth of immunity against diverse PRRS isolates. This review provides insights on immunization efforts using infectious PRRSV-based vaccines since the 1990s, beginning with live PRRSV immunization, development and commercialization of PRRSV-MLV, and strategies to overcome the deficiencies of PRRSV-MLV through use of replicating viral vectors expressing multiple PRRSV membrane proteins. Finally, powerful reverse genetics systems (infectious cDNA clones) generated from more than 20 PRRSV isolates of both genotypes 1 and 2 viruses have provided a great resource for exploring many innovative strategies to improve the safety and cross-protective efficacy of live PRRSV vaccines. Examples include vaccines with diminished ability to down-regulate the immune system, positive and negative marker vaccines, multivalent vaccines incorporating antigens from other porcine pathogens, vaccines that carry their own cytokine adjuvants, and chimeric vaccine viruses with the potential for broad cross-protection against heterologous strains. To combat this devastating pig disease in the future, evaluation and commercialization of such improved live PRRSV vaccines is a shared goal among PRRSV researchers, pork

  2. Stroke Prevention in Atrial Fibrillation: Current Strategies and Recommendations

    Directory of Open Access Journals (Sweden)

    Gerald V. Naccarelli, MD

    2016-02-01

    Full Text Available Stroke is the most common complication of atrial fibrillation (AF. Guidelines recommend anticoagulant treatment in patients with CHA2DS2VASc scores of >2. Registry data suggests that almost half of patients who should be on therapeutic anticoagulation for stroke prevention in AF (SPAF are not. Warfarin and more recently developed agents, the “novel anticoagulants” (NOACs reduce the risk of embolic strokes. In addition, the NOACs also reduce intracranial hemorrhage (ICH by over 50% compared to warfarin. Anticoagulation and bridging strategies involving cardioversion, catheter ablation, and invasive/surgical procedures are reviewed. The development of reversal agents for NOACs and the introduction of left atrial appendage occluding devices will evolve the use of newer strategies for preventing stroke in high risk AF patients.

  3. Current Strategies to Improve the Bioactivity of PEEK

    Science.gov (United States)

    Ma, Rui; Tang, Tingting

    2014-01-01

    The synthetic thermoplastic polymer polyetheretherketone (PEEK) is becoming a popular component of clinical orthopedic and spinal applications, but its practical use suffers from several limitations. Although PEEK is biocompatible, chemically stable, radiolucent and has an elastic modulus similar to that of normal human bone, it is biologically inert, preventing good integration with adjacent bone tissues upon implantation. Recent efforts have focused on increasing the bioactivity of PEEK to improve the bone-implant interface. Two main strategies have been used to overcome the inert character of PEEK. One approach is surface modification to activate PEEK through surface treatment alone or in combination with a surface coating. Another strategy is to prepare bioactive PEEK composites by impregnating bioactive materials into PEEK substrate. Researchers believe that modified bioactive PEEK will have a wide range of orthopedic applications. PMID:24686515

  4. Individualized Plastic Reconstruction Strategy for Patients With Ectodermal Dysplasia Syndrome.

    Science.gov (United States)

    Hou, Yikang; Jin, Yunbo; Lin, Xiaoxi; Chai, Gang; Zhang, Yan; Qi, Zuoliang

    2017-06-01

    Ectodermal dysplasia syndrome is a hereditary disease of ectodermal origin. Appearances of nail dystrophy, alopecia or hypotrichosis, saddle nose deformity, and palmoplantar hyperkeratosis are usually associated with a lack of sweat glands as well as partial or complete absence of teeth. These manifestations are usually corrected only with oral rehabilitation by mounting dentures. In this study, plastic rehabilitation was developed to correct the special features of patients with ectodermal dysplasia. Four men and 1 woman with ectodermal dysplasia syndrome were treated. Four patients showed dysostosis of the midface, and rhinoplasty with costal bone was performed, whereas cosmetic operation aiming to repair soft tissue defects was adopted for the last patient. After plastic corrections, all 5 patients were satisfied with the results and had no social embarrassment.

  5. Treatment strategies for the infertile polycystic ovary syndrome patient.

    Science.gov (United States)

    Tannus, Samer; Burke, Yechiel Z; Kol, Shahar

    2015-11-01

    Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Infertility is a prevalent presenting feature of PCOS, and approximately 75% of these women suffer infertility due to anovulation. Lifestyle modification is considered the first-line treatment and is associated with improved endocrine profile. Clomiphene citrate (CC) should be considered as the first line pharmacologic therapy for ovulation induction. In women who are CC resistant, second-line treatment should be considered, as adding metformin, laparoscopic ovarian drilling or treatment with gonadotropins. In CC treatment failure, Letrozole could be an alternative or treatment with gonadotropins. IVF is considered the third-line treatment; the 'short', antagonist-based protocol is the preferred option for PCOS patients, as it is associated with lower risk of developing ovarian hyperstimulation syndrome (specifically by using a gonadotropin--releasing hormone agonist as ovulation trigger), but with comparable outcomes as the long protocol.

  6. Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Ahmet Karabulut

    2015-10-01

    Full Text Available Significant left main coronary artery (LMCA stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES, extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion. However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI. In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management.

  7. History, genetics, and strategies for cancer prevention in Lynch syndrome.

    Science.gov (United States)

    Kastrinos, Fay; Stoffel, Elena M

    2014-05-01

    Colorectal cancer (CRC) is the most common gastrointestinal malignancy and the third cause of cancer death in men and women in the United States. The majority of CRC cases diagnosed annually are due to sporadic events, but up to 6% are attributed to known monogenic disorders that confer a markedly increased risk for the development of CRC and multiple extracolonic malignancies. Lynch syndrome is the most common inherited CRC syndrome and is associated with mutations in DNA mismatch repair genes, mainly MLH1 and MSH2 but also MSH6, PMS2, and EPCAM. Although the risk of CRC and endometrial cancer may approach near 75% and 50%, respectively, in gene mutation carriers, the identification of these individuals and at-risk family members through predictive genetic testing provides opportunities for cancer prevention including specialized cancer screening, intensified surveillance, and/or prophylactic surgeries. This article will provide a review of the major advances in risk assessment, molecular genetics, DNA mutational analyses, and cancer prevention and management made since Lynch syndrome was first described 100 years ago. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  8. Duane retraction syndrome: causes, effects and management strategies

    Directory of Open Access Journals (Sweden)

    Kekunnaya R

    2017-10-01

    Full Text Available Ramesh Kekunnaya, Mithila Negalur Pediatric Ophthalmology and Strabismus Services, Child Sight Institute, Jasti V Ramannama Children’s Eye Care Center, KAR Campus, Hyderabad, India Abstract: Duane retraction syndrome (DRS is a congenital eye movement anomaly characterized by variable horizontal duction deficits, with narrowing of the palpebral fissure and globe retraction on attempted adduction, occasionally accompanied by upshoot or downshoot. The etiopathogenesis of this condition can be explained by a spectrum of mechanical, innervational, neurologic and genetic abnormalities occurring independently or which influence each other giving rise to patterns of clinical presentations along with a complex set of ocular and systemic anomalies. Huber type I DRS is the most common form of DRS with an earlier presentation, while Huber type II is the least common presentation. Usually, patients with unilateral type I Duane syndrome have esotropia more frequently than exotropia, those with type II have exotropia and those with type III have esotropia and exotropia occurring equally common. Cases of bilateral DRS may have variable presentation depending upon the type of presentation in each eye. As regards its management, DRS classification based on primary position deviation as esotropic, exotropic or orthotropic is more relevant than Huber’s classification before planning surgery. Surgical approach to these patients is challenging and must be individualized based on the amount of ocular deviation, abnormal head position, associated globe retraction and overshoots. Keywords: Duane syndrome, strabismus surgery, esotropia, overshoots

  9. Determining the anaerobic threshold in postpolio syndrome: comparison with current guidelines for training intensity prescription

    NARCIS (Netherlands)

    Voorn, Eric L.; Gerrits, Karin H.; Koopman, Fieke S.; Nollet, Frans; Beelen, Anita

    2014-01-01

    To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT. Cohort study. Research laboratory. Individuals with PPS

  10. Current Therapeutic Strategies and Novel Approaches in Osteosarcoma

    International Nuclear Information System (INIS)

    Ando, Kosei; Heymann, Marie-Françoise; Stresing, Verena; Mori, Kanji; Rédini, Françoise; Heymann, Dominique

    2013-01-01

    Osteosarcoma is the most frequent malignant primary bone tumor and a main cause of cancer-related death in children and adolescents. Although long-term survival in localized osteosarcoma has improved to about 60% during the 1960s and 1970s, long-term survival in both localized and metastatic osteosarcoma has stagnated in the past several decades. Thus, current conventional therapy consists of multi-agent chemotherapy, surgery and radiation, which is not fully adequate for osteosarcoma treatment. Innovative drugs and approaches are needed to further improve outcome in osteosarcoma patients. This review describes the current management of osteosarcoma as well as potential new therapies

  11. Current strategies in surgical myocardial revascularization: Indian perspective

    Directory of Open Access Journals (Sweden)

    Sameer Kumar

    2013-01-01

    A retrospective analysis was carried out of 172 patients who underwent CABG at INHS Asvini between 01 Jan 2008 and 31 May 2013.39% had Left Main Coronary artery disease, 85% patient had triple vessel disease, 56% were diabetics, 12% had undergone stenting in recent past. Beating heart strategy was used in 10%, average no of grafts per patient was 2.3 with LIMA and Radial artery being used as a conduit in 84% and 4% respectively. 4.6% patients succumbed in post-operative period.

  12. Oral insulin delivery: existing barriers and current counter-strategies.

    Science.gov (United States)

    Gedawy, Ahmed; Martinez, Jorge; Al-Salami, Hani; Dass, Crispin R

    2018-02-01

    The chronic and progressive nature of diabetes is usually associated with micro- and macrovascular complications where failure of pancreatic β-cell function and a general condition of hyperglycaemia is created. One possible factor is failure of the patient to comply with and adhere to the prescribed insulin due to the inconvenient administration route. This review summarizes the rationale for oral insulin administration, existing barriers and some counter-strategies trialled. Oral insulin mimics the physiology of endogenous insulin secreted by pancreas. Following the intestinal absorption of oral insulin, it reaches the liver at high concentration via the portal vein. Oral insulin on the other hand has the potential to protect pancreatic β-cells from autoimmune destruction. Structural modification, targeting a particular tissue/receptor, and the use of innovative pharmaceutical formulations such as nanoparticles represent strategies introduced to improve oral insulin bioavailability. They showed promising results in overcoming the hurdles facing oral insulin delivery, although delivery is far from ideal. The use of advanced pharmaceutical technologies and further research in particulate carrier system delivery predominantly nanoparticle utilization would offer useful tools in delivering insulin via the oral route which in turn would potentially improve diabetic patient compliance to insulin and the overall management of diabetes. © 2017 Royal Pharmaceutical Society.

  13. [From tic disorders to Tourette syndrome: current data, comorbidities, and therapeutic approach in children].

    Science.gov (United States)

    Fourneret, P; Desombre, H; Broussolle, E

    2014-06-01

    Motor tics are frequently observed in children during development. Usually transient and benign, they can become chronic over time, join various morbid disorders (vocal tics, attention deficit and hyperactivity disorder, and obsessive-compulsive disorders) and move toward genuine Tourette syndrome. In this case, it will be necessary to prevent impacts - mainly in terms of quality of life and emotional and relational problems - using a global therapeutic strategy combining psychoeducational approaches with appropriate medication. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Gestational Diabetes Mellitus: a review of current diagnostic strategies concepts

    Directory of Open Access Journals (Sweden)

    Juan Sebastián Frías-Ordoñez

    2016-10-01

    Full Text Available Gestational diabetes mellitus (GDM is a state of carbohydrate intolerance that is first recognized during pregnancy. The initial criteria for diagnosis were established more than 50 years ago by O’Sullivan & Mahan, and since then, some modifications have been made. Currently, diagnosis considers two methods: the onestep approach, consisting of an oral glucose tolerance test (OGTT for 2 hours with 75g of glucose, and the two-step approach, which involves an initial screening test with 50g of glucose and OGTT with 100g of glucose if screening is positive. Both diagnostic approaches have been justified by expert consensus; however, an absolute concept about the method to be applied has not been established yet. To select a method, the clinician must take into account various factors. This paper proposes a historical overview and the presentation of the current status of GDM diagnosis.

  15. Power electronic converters PWM strategies and current control techniques

    CERN Document Server

    Monmasson, Eric

    2013-01-01

    A voltage converter changes the voltage of an electrical power source and is usually combined with other components to create a power supply. This title is devoted to the control of static converters, which deals with pulse-width modulation (PWM) techniques, and also discusses methods for current control. Various application cases are treated. The book is ideal for professionals in power engineering, power electronics, and electric drives industries, as well as practicing engineers, university professors, postdoctoral fellows, and graduate students.

  16. Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial

    NARCIS (Netherlands)

    Hoedemaker, N.P.G.; Damman, P.; Woudstra, P.; Hirsch, A.; Windhausen, F.; Tijssen, J.G.; Winter, R.J. de; Verheugt, F.W.A.; et al.,

    2017-01-01

    BACKGROUND: The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term

  17. Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial

    NARCIS (Netherlands)

    Hoedemaker, Niels P. G.; Damman, Peter; Woudstra, Pier; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; de Winter, Robbert J.; Peters, R. J. G.; Dunselman, P. H. J. M.; Verheugt, F. W. A.; Janus, C. L.; Umans, V.; Bendermacher, P. E. F.; Michels, H. R.; Sadé e, A.; Hertzberger, D.; de Miliano, P. A. R. M.; Liem, A. H.; Tjon Joe Gin, R.; van der Linde, M.; Lok, D.; Hoedemaker, G.; Pieterse, M.; van den Merkhof, L.; Danië ls, M.; van Hessen, M.; Hermans, W.; Schotborgh, C. E.; de Zwaan, C.; Bredero, A.; de Jaegere, P.; Janssen, M.; Louwerenburg, J.; Veerhoek, M.; Schalij, M.; de Porto, A.; Zijlstra, F.; Winter, J.; de Feyter, P.; Robles de Medina, R.; Withagen, P.; Sedney, M.; Thijssen, H.; van Rees, C.; van den Bergh, P.; de Cock, C.; van 't Hof, A.; Suttorp, M. J.; Windhausen, F.; Cornel, J. H.

    2017-01-01

    The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an

  18. Current status and some aspects of the future energy strategy

    International Nuclear Information System (INIS)

    Antic, D. P.; Sokcic-Kostic, M. S. . E-mail address of corresponding author: dragon@vin.bg.ac.yu; Antic, D.)

    2005-01-01

    Current status of the energy production and of the energy sources in the world, European Union, Serbia and Montenegro and the Balkan states is analyzed. Some trends in the energy consumption and productions in some European states are analyzed. Some problems of the Serbia and Montenegro energy production system are compared with situation in neighbor states, Germany, and European Union. At present, anywhere in the world, the nuclear power in on the defensive. In some countries it has been even outlawed. Some parameters show that nuclear power, on the global scale and during this century at least, is absolutely essential and reasons for revival of nuclear energy are realistic. (author)

  19. Maternal mortality in India: current status and strategies for reduction.

    Science.gov (United States)

    Prakash, A; Swain, S; Seth, A

    1991-12-01

    The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the

  20. A Current Limiting Strategy to Improve Fault Ride-Through of Inverter Interfaced Autonomous Microgrids

    DEFF Research Database (Denmark)

    Sadeghkhani, Iman; Esmail Hamedani Golshan, Mohamad; Guerrero, Josep M.

    2017-01-01

    With high penetration of distributed energy resources (DER), fault management strategy is of great importance for the distribution network operation. The objective of this paper is to propose a current and voltage limiting strategy to enhance fault ride-through (FRT) capability of inverter...... for both four- and three-wire configurations. The proposed strategy provides high voltage and current quality during overcurrent conditions, which is necessary for sensitive loads. Several time-domain simulation studies are conducted to investigate the FRT capability of the proposed strategy against both...... asymmetrical and symmetrical faults. Moreover, the proposed method is tested on the CIGRE benchmark microgrid to demonstrate the effectiveness of the proposed limiting strategy....

  1. Current strategies for the treatment of aneurysmal bone cysts

    Directory of Open Access Journals (Sweden)

    Panagiotis Tsagozis

    2015-12-01

    Full Text Available Aneurysmal bone cysts are benign bone tumors that usually present in childhood and early adulthood. They usually manifest as expansile osteolytic lesions with a varying potential to be locally aggressive. Since their first description in 1942, a variety of treatment methods has been proposed. Traditionally, these tumors were treated with open surgery. Either intralesional surgical procedures or en bloc excisions have been described. Furthermore, a variety of chemical or physical adjuvants has been utilized in order to reduce the risk for local recurrence after excision. Currently, there is a shift to more minimally invasive procedures in order to avoid the complications of open surgical excision. Good results have been reported during percutaneous surgery, or the use of embolization. Recently, sclerotherapy has emerged as a promising treatment, showing effective consolidation of the lesions and functional results that appear to be superior to the ones of open surgery. Lastly, non-invasive treatment, such as pharmaceutical intervention with denosumab or bisphosphonates has been reported to be effective in the management of the disease. Radiotherapy has also been shown to confer good local control, either alone or in conjunction to other treatment modalities, but is associated with serious adverse effects. Here, we review the current literature on the methods of treatment of aneurysmal bone cysts. The indication for each type of treatment along reported outcome of the intervention, as well as potential complications are systematically presented. Our review aims to increase awareness of the different treatment modalities and facilitate decision-making regarding each individual patient.

  2. Building Visual Artists’ Resilience Capabilities: Current Educator Strategies and Methods

    Directory of Open Access Journals (Sweden)

    Eileen Maree Siddins

    2016-07-01

    Full Text Available Enrolments in higher education programs in the creative and performing arts are increasing in many countries. Yet graduates of these degrees, who enter the broad sector known as the creative industries, face particular challenges in terms of securing long-term and sustainable employment. In addition, creative and performing artists face a range of mental challenges, caused by such factors as: the solitary nature of much creative practice, critical feedback by audiences and gatekeepers, or the general pressures associated with maintaining artistic relevance or integrity. The concepts of resilience and professional wellbeing are therefore highly relevant to those who pursue a career in creative industries, and while there has been an emerging body of work in this area, to date it has focussed on the performing arts area (e.g. music, theatre. Hence, in order to expand knowledge relevant to resilience and artists, this paper sets out to explore the extent to which current educators in the Australian context specifically address these issues within higher visual arts curricula; specifically the areas of illustration, design, film and photography. This was achieved via interviews with seventeen current academics working in these areas. The findings propose that higher education providers of programs in the visual arts consider placing a stronger emphasis on the embedded development of resilience and professional wellbeing capacities.

  3. Reference materials for molecular diagnostics: Current achievements and future strategies.

    Science.gov (United States)

    Jing, Rongrong; Wang, Huimin; Ju, Shaoqing; Cui, Ming

    2018-06-01

    Molecular diagnoses have become more widespread in many areas of laboratory medicine where qualitative or quantitative approaches are used to detect nucleic acids. The increasing number of assay methods and the targets for molecular diagnostics contribute to variability in the test results among clinical laboratories. Thus, reference materials (RMs) are required to enhance the comparability of results. This review focuses on the definition of RMs as well as the production and characteristics of higher order RMs from different organizations and their future strategies. We describe the recent progress in RMs, including the definition of RMs by the Joint Committee for Guides in Metrology, as well as the production and characteristics of higher order RMs by international official bodies. There is an urgent need for RMs in nucleic acid testing, especially higher order RMs. To advance the harmonization and standardization of clinical nucleic acid detection, cooperation between the above organizations is proposed and different approaches to higher order RMs development are also needed. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  4. Optimal breast cancer screening strategies for older women: current perspectives

    Directory of Open Access Journals (Sweden)

    Braithwaite D

    2016-02-01

    Full Text Available Dejana Braithwaite,1 Joshua Demb,1 Louise M Henderson2 1Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, 2Department of Radiology, University of North Carolina, Chapel Hill, NC, USA Abstract: Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models. Keywords: aging, breast cancer, precision cancer screening

  5. Oncolytic Immunotherapy: Conceptual Evolution, Current Strategies, and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Zong Sheng Guo

    2017-05-01

    Full Text Available The concept of oncolytic virus (OV-mediated cancer therapy has been shifted from an operational virotherapy paradigm to an immunotherapy. OVs often induce immunogenic cell death (ICD of cancer cells, and they may interact directly with immune cells as well to prime antitumor immunity. We and others have developed a number of strategies to further stimulate antitumor immunity and to productively modulate the tumor microenvironment (TME for potent and sustained antitumor immune cell activity. First, OVs have been engineered or combined with other ICD inducers to promote more effective T cell cross-priming, and in many cases, the breaking of functional immune tolerance. Second, OVs may be armed to express Th1-stimulatory cytokines/chemokines or costimulators to recruit and sustain the potent antitumor immunity into the TME to focus their therapeutic activity within the sites of disease. Third, combinations of OV with immunomodulatory drugs or antibodies that recondition the TME have proven to be highly promising in early studies. Fourth, combinations of OVs with other immunotherapeutic regimens (such as prime-boost cancer vaccines, CAR T cells; armed with bispecific T-cell engagers have also yielded promising preliminary findings. Finally, OVs have been combined with immune checkpoint blockade, with robust antitumor efficacy being observed in pilot evaluations. Despite some expected hurdles for the rapid translation of OV-based state-of-the-art protocols, we believe that a cohort of these novel approaches will join the repertoire of standard cancer treatment options in the near future.

  6. Unresectable liver metastases in colorectal cancer: review of current strategies.

    Science.gov (United States)

    Sueur, Benjamin; Pellerin, Olivier; Voron, Thibault; Pointet, Anne L; Taieb, Julien; Pernot, Simon

    2016-12-01

    The objective of the treatment of colorectal cancer patients with unresectable liver metastases should be clearly defined at the outset. Potentially resectable patients should be distinguished from clearly unresectable patients. In defining resectability, it is important to take into account both anatomic characteristics and patient characteristic (comorbidities, symptoms, age). According to this evaluation, treatment should be tailored to each patient. The most widely accepted standard is doublet cytotoxic regimen plus biotherapy (anti-EGFR or anti-VEGF antibodies according to RAS status, but some patients could benefit from an intensified regimen, as triplet chemotherapy ± bevacizumab, or intraarterial treatments (hepatic arterial infusion, radioembolization or chemoembolization), in order to allow resectability. It is therefore very important to discuss the treatments with a multidisciplinary team, including an experienced surgeon, an interventional radiologist and an oncologist. On the other hand, some patients could benefit in terms of quality of life and decreased toxicity from less intense treatment when resection is not an objective. First-line monotherapy or a maintenance strategy with biotherapy and/or cytotoxics could be discussed with these patients, and treatment holidays should be considered in selected patients. Finally, in patients with secondary resection of liver metastases, specificity should be considered in choosing the best adjuvant treatment, such as response to preoperative treatment and individual risk of relapse, which many in some cases justify intensification with hepatic arterial infusion in an adjuvant setting.

  7. A review of current treatment strategies for gestational diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kristi W Kelley

    2015-07-01

    Full Text Available Approximately 90% of diabetes cases in pregnant women are considered gestational diabetes mellitus (GDM. It is well known that uncontrolled glucose results in poor pregnancy outcomes in both the mother and fetus. Worldwide there are many guidelines with recommendations for appropriate management strategies for GDM once lifestyle modifications have been instituted and failed to achieve control. The efficacy and particularly the safety of other treatment modalities for GDM has been the source of much debate in recent years. Studies that have demonstrated the safety and efficacy of both glyburide and metformin in the management of patients with GDM will be reviewed. There is a lack of evidence with other oral and injectable non-insulin agents to control blood glucose in GDM. The role of insulin will be discussed, with emphasis on insulin analogs. Ideal patient characteristics for each treatment modality will be reviewed. In addition, recommendations for postpartum screening of patients will be described as well as recommendations for use of agents to manage subsequent type 2 diabetes in patients who are breastfeeding.

  8. Cognitive coping strategies and stress in parents of children with Down syndrome: a prospective study

    NARCIS (Netherlands)

    van der Veek, Shelley M. C.; Kraaij, Vivian; Garnefski, Nadia

    2009-01-01

    The purpose of this study was to explore the cross-sectional and prospective relationships between cognitive coping strategies and parental stress in parents of children with Down syndrome. A total of 621 participants filled out questionnaires, including the Cognitive Emotion Regulation

  9. Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome

    DEFF Research Database (Denmark)

    Gustafsson, Ida; Hvelplund, Anders; Hansen, Kim Wadt

    2015-01-01

    BACKGROUND: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes. METHODS AND ...

  10. Specific or general exercise strategy for subacromial impingement syndrome-does it matter?

    DEFF Research Database (Denmark)

    Shire, Alison R; Stæhr, Thor A B; Overby, Jesper B

    2017-01-01

    Background Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise stra...

  11. A Social-Behavioral Learning Strategy Intervention for a Child with Asperger Syndrome: Brief Report

    Science.gov (United States)

    Bock, Marjorie A.

    2007-01-01

    This study examined the effect of a social-behavioral learning strategy intervention (Stop-Observe-Deliberate-Act; SODA) on the social interaction skills of one middle school student with Asperger syndrome (AS). More specifically, the study investigated the effect of SODA training on the ability of one student with AS to participate in cooperative…

  12. Carpal tunnel syndrome. Risk factors and preventive strategies for the dental hygienist.

    Science.gov (United States)

    Gerwatowski, L J; McFall, D B; Stach, D J

    1992-02-01

    Carpal tunnel syndrome (CTS) is well recognized as an occupational risk for dental hygienists. The contributing risk factors fall primarily into two categories: medical and occupational. The purposes of this paper are to examine the factors that predispose one to CTS in order to increase awareness among dental hygienists, and to offer preventive strategies that can be incorporated into daily practice.

  13. Book Review: Current Issues in International Human Resource Management and Strategy Research

    DEFF Research Database (Denmark)

    Gretzinger, Susanne

    2009-01-01

    The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer.......The article reviews the book "Current Issues in International Human Resource Management and Strategy Research," edited by Marion Festing and Susanne Royer....

  14. Ebola virus outbreak, updates on current therapeutic strategies.

    Science.gov (United States)

    Elshabrawy, Hatem A; Erickson, Timothy B; Prabhakar, Bellur S

    2015-07-01

    Filoviruses are enveloped negative-sense single-stranded RNA viruses, which include Ebola and Marburg viruses, known to cause hemorrhagic fever in humans with a case fatality of up to 90%. There have been several Ebola virus outbreaks since the first outbreak in the Democratic Republic of Congo in 1976 of which, the recent 2013-2015 epidemic in Guinea, Liberia, and Sierra Leone is the largest in recorded history. Within a few months of the start of the outbreak in December 2013, thousands of infected cases were reported with a significant number of deaths. As of March 2015, according to the Centers for Disease Control and Prevention, there have been nearly 25,000 suspected cases, with 15,000 confirmed by laboratory testing, and over 10,000 deaths. The large number of cases and the high mortality rate, combined with the lack of effective Food and Drug Administration-approved treatments, necessitate the development of potent and safe therapeutic measures to combat the current and future outbreaks. Since the beginning of the outbreak, there have been considerable efforts to develop and characterize protective measures including vaccines and antiviral small molecules, and some have proven effective in vitro and in animal models. Most recently, a cocktail of monoclonal antibodies has been shown to be highly effective in protecting non-human primates from Ebola virus infection. In this review, we will discuss what is known about the nature of the virus, phylogenetic classification, genomic organization and replication, disease transmission, and viral entry and highlight the current approaches and efforts, in the development of therapeutics, to control the outbreak. Copyright © 2015 John Wiley & Sons, Ltd.

  15. Primary prevention of diabetes mellitus: current strategies and future trends

    Directory of Open Access Journals (Sweden)

    Prasanta K. Bhattacharya

    2016-04-01

    Full Text Available Aim of this paper is to find evidence for primary prevention of type-2 diabetes mellitus (T2DM from epidemiological studies and clinical trials, and the feasibility of applying these interventions in resource limited countries. T2DM, which accounts for more than nine-tenths of all diabetics, results from inadequate insulin secretion or underlying insulin resistance. The prevalence of diabetes, mainly T2DM, has increased rapidly during the last few decades worldwide. Since the genetic background is unlikely to change during this short time period, the growing epidemic of T2DM is more likely due to changes in environmental or lifestyle risk factors including obesity, physical inactivity, smoking, alcohol and stress. The scope and feasibility for primary prevention of T2DM is based on elimination of these risk factors. This evidence that T2DM is preventable comes from epidemiologic studies and clinical trials of effect of lifestyle changes and drugs in development of T2DM. The positive effects are more profound and safer with lifestyle modifications (LSM compared to medications. This is shown to be effective globally, across various ethnicities and races and sustainable on long-term follow-up. However, there is a major challenge in translating this evidence into economically viable and sustained community programs, as these LSM interventions are expensive, even from western standards point of view. Future plan should focus on health education of the public, improving the national capacity to detect and manage the environmental risks including strategies to reduce stress, and development of innovative, cost effective, and scalable methodologies.

  16. Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence.

    Science.gov (United States)

    Warth, Ryan J; Spiegl, Ulrich J; Millett, Peter J

    2015-01-01

    Symptomatic scapulothoracic disorders, such as painful scapular crepitus and/or bursitis, are uncommon; however, they can produce significant pain and disability in many patients. To review the current knowledge pertaining to snapping scapula syndrome and to identify areas of further research that may be helpful to improve clinical outcomes and patient satisfaction. Systematic review. We performed a preliminary search of the PubMed and Embase databases using the search terms "snapping scapula," "scapulothoracic bursitis," "partial scapulectomy," and "superomedial angle resection" in September 2013. All nonreview articles related to the topic of snapping scapula syndrome were included. The search identified a total of 167 unique articles, 81 of which were relevant to the topic of snapping scapula syndrome. There were 36 case series of fewer than 10 patients, 16 technique papers, 11 imaging studies, 9 anatomic studies, and 9 level IV outcomes studies. The level of evidence obtained from this literature search was inadequate to perform a formal systematic review or meta-analysis. Therefore, a critical review of current evidence is presented. Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction. © 2014 The Author(s).

  17. Surgical Strategy in Bouveret's Syndrome. A Case Report

    Directory of Open Access Journals (Sweden)

    Dénes Márton István

    2016-06-01

    Full Text Available Bouveret's syndrome is a high mechanical obstruction due to impaction of a gallstone into the duodenum, through a cholecystoduodenal fistula. It belongs to a larger group of gallstone ileus, a disease which occurs after developing a fistula between the gallbladder and the gastrointestinal tract. This is a rare complication of gallstones but because it appears in elderly people, it has a high morbidity and mortality. Patients have various symptoms and the treatment is individualized. We present here a case of a 67 years old patient, admitted in emergency, presenting symptoms of high bowel obstruction, with onset 5 days before admission. Abdominal ultrasound reveals a 5 cm stone that seems to be in the gallbladder, gastric stasis and at gastroscopy appears a foreign body impacted in the duodenum. After a short preparation the patient underwent surgery. We found a dilated stomach and a large cholecystoduodenal fistula with an impacted gallstone in the duodenum. We performed one stage surgery: cholecystectomy, extraction of the stone and suturing of the fistula. We reestablished the continuity of the intestinal tract. We performed also an ileostomy for feeding the patient and protecting the anastomoses. The postoperative evolution was favorable.

  18. Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics

    Science.gov (United States)

    Pozza, Carlotta; Graziadio, Chiara; Giannetta, Elisa; Lenzi, Andrea; Isidori, Andrea M.

    2012-01-01

    Cushing's syndrome (CS) is a rare but severe clinical condition represented by an excessive endogenous cortisol secretion and hence excess circulating free cortisol, characterized by loss of the normal feedback regulation and circadian rhythm of the hypothalamic-pituitary axis due to inappropriate secretion of ACTH from a pituitary tumor (Cushing's disease, CD) or an ectopic source (ectopic ACTH secretion, EAS). The remaining causes (20%) are ACTH independent. As soon as the diagnosis is established, the therapeutic goal is the removal of the tumor. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. A multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists should be adopted. This paper will focus on traditional and novel medical therapy for aggressive ACTH-dependent CS. Several drugs are able to reduce cortisol levels. Their mechanism of action involves blocking adrenal steroidogenesis (ketoconazole, metyrapone, aminoglutethimide, mitotane, etomidate) or inhibiting the peripheral action of cortisol through blocking its receptors (mifepristone “RU-486”). Other drugs include centrally acting agents (dopamine agonists, somatostatin receptor agonists, retinoic acid, peroxisome proliferator-activated receptor γ “PPAR-γ” ligands) and novel chemotherapeutic agents (temozolomide and tyrosine kinase inhibitors) which have a significant activity against aggressive pituitary or ectopic tumors. PMID:22934113

  19. Management Strategies for Aggressive Cushing's Syndrome: From Macroadenomas to Ectopics

    Directory of Open Access Journals (Sweden)

    Carlotta Pozza

    2012-01-01

    Full Text Available Cushing’s syndrome (CS is a rare but severe clinical condition represented by an excessive endogenous cortisol secretion and hence excess circulating free cortisol, characterized by loss of the normal feedback regulation and circadian rhythm of the hypothalamic-pituitary axis due to inappropriate secretion of ACTH from a pituitary tumor (Cushing’s disease, CD or an ectopic source (ectopic ACTH secretion, EAS. The remaining causes (20% are ACTH independent. As soon as the diagnosis is established, the therapeutic goal is the removal of the tumor. Whenever surgery is not curative, management of patients with CS requires a major effort to control hypercortisolemia and associated symptoms. A multidisciplinary approach that includes endocrinologists, neurosurgeons, oncologists, and radiotherapists should be adopted. This paper will focus on traditional and novel medical therapy for aggressive ACTH-dependent CS. Several drugs are able to reduce cortisol levels. Their mechanism of action involves blocking adrenal steroidogenesis (ketoconazole, metyrapone, aminoglutethimide, mitotane, etomidate or inhibiting the peripheral action of cortisol through blocking its receptors (mifepristone “RU-486”. Other drugs include centrally acting agents (dopamine agonists, somatostatin receptor agonists, retinoic acid, peroxisome proliferator-activated receptor γ “PPAR-γ” ligands and novel chemotherapeutic agents (temozolomide and tyrosine kinase inhibitors which have a significant activity against aggressive pituitary or ectopic tumors.

  20. Dietary Strategies Implicated in the Prevention and Treatment of Metabolic Syndrome.

    Science.gov (United States)

    de la Iglesia, Rocio; Loria-Kohen, Viviana; Zulet, Maria Angeles; Martinez, Jose Alfredo; Reglero, Guillermo; Ramirez de Molina, Ana

    2016-11-10

    Metabolic syndrome (MetS) is established as the combination of central obesity and different metabolic disturbances, such as insulin resistance, hypertension and dyslipidemia. This cluster of factors affects approximately 10%-50% of adults worldwide and the prevalence has been increasing in epidemic proportions over the last years. Thus, dietary strategies to treat this heterogenic disease are under continuous study. In this sense, diets based on negative-energy-balance, the Mediterranean dietary pattern, n-3 fatty acids, total antioxidant capacity and meal frequency have been suggested as effective approaches to treat MetS. Furthermore, the type and percentage of carbohydrates, the glycemic index or glycemic load, and dietary fiber content are some of the most relevant aspects related to insulin resistance and impaired glucose tolerance, which are important co-morbidities of MetS. Finally, new studies focused on the molecular action of specific nutritional bioactive compounds with positive effects on the MetS are currently an objective of scientific research worldwide. The present review summarizes some of the most relevant dietary approaches and bioactive compounds employed in the treatment of the MetS to date.

  1. Dietary Strategies Implicated in the Prevention and Treatment of Metabolic Syndrome

    Directory of Open Access Journals (Sweden)

    Rocio de la Iglesia

    2016-11-01

    Full Text Available Metabolic syndrome (MetS is established as the combination of central obesity and different metabolic disturbances, such as insulin resistance, hypertension and dyslipidemia. This cluster of factors affects approximately 10%–50% of adults worldwide and the prevalence has been increasing in epidemic proportions over the last years. Thus, dietary strategies to treat this heterogenic disease are under continuous study. In this sense, diets based on negative-energy-balance, the Mediterranean dietary pattern, n-3 fatty acids, total antioxidant capacity and meal frequency have been suggested as effective approaches to treat MetS. Furthermore, the type and percentage of carbohydrates, the glycemic index or glycemic load, and dietary fiber content are some of the most relevant aspects related to insulin resistance and impaired glucose tolerance, which are important co-morbidities of MetS. Finally, new studies focused on the molecular action of specific nutritional bioactive compounds with positive effects on the MetS are currently an objective of scientific research worldwide. The present review summarizes some of the most relevant dietary approaches and bioactive compounds employed in the treatment of the MetS to date.

  2. Therapy strategies for Usher syndrome Type 1C in the retina.

    Science.gov (United States)

    Nagel-Wolfrum, Kerstin; Baasov, Timor; Wolfrum, Uwe

    2014-01-01

    The Usher syndrome (USH) is the most common form of inherited deaf-blindness with a prevalence of ~ 1/6,000. Three clinical subtypes (USH1-USH3) are defined according to the severity of the hearing impairment, the presence or absence of vestibular dysfunction and the age of onset of retinitis pigmentosa (RP). USH1 is the most severe subtype with congenital severe to profound hearing loss and onset of RP before puberty. Currently only the amelioration of the hearing deficiency is implemented, but no treatment of the senso-neuronal degeneration in the eye exists.In our studies we are focusing on the evaluation of gene-based therapies to cure the retinal degeneration of USH1C patients: (i) gene augmentation using recombinant adeno-associated virus, (ii) genome editing by homologous recombination mediated by zinc-finger nucleases and, (iii) read-through therapy using novel designer aminoglycosides and PTC124. Latter compounds target in-frame nonsense mutations which account for ~ 20 % of all USH cases.All analyzed gene-based therapy strategies lead to the restoration of USH protein expression. These adjustments may be sufficient to reduce the progression of retinal degeneration, which would greatly improve the life quality of USH patients.

  3. [Surgical treatment of Marfan syndrome; late results and new strategy].

    Science.gov (United States)

    Aomi, S; Nonoyama, M; Tomioka, H; Endo, M; Nagashima, H; Sakomura, Y; Aoka, Y; Kasanuki, H; Kurosawa, H

    2002-07-01

    Rapid progress has been made in the treatment of Marfan syndrome. Today, the treatment is relatively established and the results have also improved. Even if surgery is performed, however, vascular lesions may recur late after operation and late prognosis is poor considering the age of patients. Issues such as whether a reoperation should be conducted or how the late results might be improved are subjects of debate. Based on an analysis of recent late data, we have performed operations according to the new treatment policy, and here report the results. A total of 203 consecutive operations were conducted in 141 patients with Marfan syndrome who underwent surgery for aortic aneurysm at our department between February 1973 and August 2001. The mean age of patients was 39 (11 years with a male/female ratio of 95:46. At the first operation, 72 patients were diagnosed with annuloaortic ectasia (AAE), 17 patients with AAE + chronic dissection (DeBakey I), 14 patients with AAE + chronic dissection (DeBakey II), 6 patients with AAE + acute dissection (Stanford A), 11 patients with AAE + dissection (DeBakey III), 9 patients with dissection (DeBakey III) only, 3 patients with AAE + abdominal aortic aneurysm only, and 2 patients with abdominal aortic aneurysm only. The cause of reoperation were a new lesion in 17 patients, dissection in 13 patients and a true aneurysm in 4 patients. In 36 patients, an increase in the remaining lesion occurred or a scheduled stage 2 operation was performed. Reoperation was performed following the Bentall operation in 7 patients, dehiscence of the anastomotic region of the coronary artery in 5 patients, aneurysm of the anastomotic region of the coronary artery in 1 patients, and infection of the artificial valve with aneurysm of the anastomotic region of the coronary artery in 1 patient. Hospital deaths were reported in 8 (6%) patients who underwent composite valve graft replacement (including simultaneous arch replacement) for AAE. Hospital

  4. [Strategies to promote testosterone deficiency syndrome: a paradigm of disease mongering].

    Science.gov (United States)

    Gavilán, Enrique; Jiménez de Gracia, Laura; Gérvas, Juan

    2014-01-01

    The so-called «testosterone deficiency syndrome» is a blend of nonspecific symptoms typical of the physiological process of aging. This syndrome has been the subject of intense promotional activity that has presented the phenomenon as highly prevalent and with a major public health impact. This strategy has been accompanied by the emergence of new and easy to administer testosterone devices into the pharmaceutical market and has generated significant sales for drug companies. The commercial promotion of testosterone deficiency syndrome and its remedies has exploited cultural stereotypes of aging and sexuality through awareness campaigns promoted by the laboratories involved and has been disseminated by media with the participation of numerous experts and with the support of scientific associations, representing a paradigmatic case of disease mongering. This example might be of use in the response to disease mongering activities from the clinical and public health fields. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  5. A DC Microgrid Coordinated Control Strategy Based on Integrator Current-Sharing

    DEFF Research Database (Denmark)

    Gao, Liyuan; Liu, Yao; Ren, Huisong

    2017-01-01

    The DC microgrid has become a new trend for microgrid study with the advantages of high reliability, simple control and low losses. With regard to the drawbacks of the traditional droop control strategies, an improved DC droop control strategy based on integrator current-sharing is introduced....... In the strategy, the principle of eliminating deviation through an integrator is used, constructing the current-sharing term in order to make the power-sharing between different distributed generation (DG) units uniform and reasonable, which can reduce the circulating current between DG units. Furthermore......, at the system coordinated control level, a hierarchical/droop control strategy based on the DC bus voltage is proposed. In the strategy, the operation modes of the AC main network and micro-sources are determined through detecting the DC voltage variation, which can ensure the power balance of the DC microgrid...

  6. Trunk, pelvis and hip biomechanics in individuals with femoroacetabular impingement syndrome: Strategies for step ascent.

    Science.gov (United States)

    Diamond, Laura E; Bennell, Kim L; Wrigley, Tim V; Hinman, Rana S; Hall, Michelle; O'Donnell, John; Hodges, Paul W

    2018-03-01

    Femoroacetabular impingment (FAI) syndrome is common among young active adults and a proposed risk factor for the future development of hip osteoarthritis. Pain is dominant and drives clinical decision-making. Evidence for altered hip joint function in this patient population is inconsistent, making the identification of treatment targets challenging. A broader assessment, considering adjacent body segments (i.e. pelvis, trunk) and individual movement strategies, may better inform treatment programs. This exploratory study aimed to compare trunk, pelvis, and hip biomechanics during step ascent between individuals with and without FAI syndrome. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery, and 11 age-, and sex-comparable pain- and disease-free individuals, underwent three-dimensional motion analysis during a step ascent task. Trunk, pelvis and hip biomechanics were compared between groups. Participants with FAI syndrome exhibited altered ipsilateral trunk lean and pelvic rise towards the symptomatic side during single-leg support compared to controls. Alterations were not uniformly adopted across all individuals with FAI syndrome; those who exhibited more pronounced alterations to frontal plane pelvis control tended to report pain during the task. There were minimal between-group differences for hip biomechanics. Exploratory data suggest biomechanics at the trunk and pelvis during step ascent differ between individuals with and without FAI syndrome. Those with FAI syndrome implement a range of proximal strategies for task completion, some of which may have relevance for rehabilitation. Longitudinal investigations of larger cohorts are required to evaluate hypothesized clinical and structural consequences. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. A Harmonic Current Suppression Control Strategy for Droop-Controlled Inverter Connected to the Distorted Grid

    DEFF Research Database (Denmark)

    Wei, Feng; Sun, Kai; Guan, Yajuan

    2015-01-01

    currents. Therefore, the reason of generation of distorted grid-feeding current of GF-VCI under the distorted grid voltage is investigated firstly in this paper. Then, a harmonic grid-feeding current suppression control strategy for GF-VCI is proposed. Two different filters are compared and analysed before...... voltage component at the point of common coupling. As a result, the difference of harmonic voltage between PCC and GF-VCI is reduced and the THDi of grid feeding-currents is decreased. Finally, the proposed control strategy is verified through simulations and experimental results....

  8. Tic Disorders and Tourette Syndrome: Current Concepts of Etiology and Treatment in Children and Adolescents.

    Science.gov (United States)

    Tagwerker Gloor, Friederike; Walitza, Susanne

    2016-04-01

    Tic disorders (TD), including chronic/persistent TD (CTD) and Tourette syndrome, have been described and studied for many years. Within the last two decades, intensified study efforts led to more specific assumptions about genesis and influences of both hereditary and environmental factors. TD in children and adolescents are very often accompanied by attention-deficit/hyperactivity disorders and obsessive-compulsive disorders (OCD) as comorbid disorders. Comorbidities are aggravating factors concerning prognosis and treatment opportunities. Therefore, etiological considerations and treatment strategies have to take associated psychiatric disorders into account. Treatment approaches are symptom targeted and include behavioral treatments and/or medication and show positive outcomes concerning tic symptomatology, global functioning, and associated psychopathology. This review presents an update of the research, definitions, and classification according to ICD-10 and DSM-5 and summarizes the diagnostic procedures and most effective clinical strategies. Georg Thieme Verlag KG Stuttgart · New York.

  9. Dietary Strategies Implicated in the Prevention and Treatment of Metabolic Syndrome

    OpenAIRE

    de la Iglesia, Rocio; Loria-Kohen, Viviana; Zulet, Maria Angeles; Martinez, Jose Alfredo; Reglero, Guillermo; Ramirez de Molina, Ana

    2016-01-01

    Metabolic syndrome (MetS) is established as the combination of central obesity and different metabolic disturbances, such as insulin resistance, hypertension and dyslipidemia. This cluster of factors affects approximately 10%–50% of adults worldwide and the prevalence has been increasing in epidemic proportions over the last years. Thus, dietary strategies to treat this heterogenic disease are under continuous study. In this sense, diets based on negative-energy-balance, the Mediterranean die...

  10. Determining the anaerobic threshold in post-polio syndrome: comparison with current guidelines for training intensity prescription.

    NARCIS (Netherlands)

    Voorn, E.L.; Gerrits, K.H.L.; Koopman, F.S.; Nollet, F.; Beelen, A.

    2014-01-01

    Objectives To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT. Design Cohort study. Setting Research

  11. Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial

    NARCIS (Netherlands)

    Bayram, Neriman; van Wely, Madelon; Kaaijk, Eugenie M.; Bossuyt, Patrick M. M.; van der Veen, Fulco

    2004-01-01

    Objective To compare the effectiveness of an electrocautery strategy with ovulation induction using recombinant follicle stimulating hormone in patients with clomiphene resistant polycystic ovary syndrome. Design Randomised controlled trial. Setting Secondary and tertiary hospitals in the

  12. Linguistic Gender Sensitivity Strategies in Current South African Intermediate Phase English Workbooks: Feminisation or Degenderisation?

    Science.gov (United States)

    Sibanda, Jabulani; Sibanda, Lucy

    2016-01-01

    This study extends research on manifestations of gender insensitivity in learners' reading materials by shifting attention to the linguistic strategies that authors of current texts employ for the realisation of gender sensitivity. We analysed the content of 12 current (2014) English workbooks (Grade 4-6) used in South African government and…

  13. Comparison of different strategies in prenatal screening for Down's syndrome: cost effectiveness analysis of computer simulation.

    Science.gov (United States)

    Gekas, Jean; Gagné, Geneviève; Bujold, Emmanuel; Douillard, Daniel; Forest, Jean-Claude; Reinharz, Daniel; Rousseau, François

    2009-02-13

    To assess and compare the cost effectiveness of three different strategies for prenatal screening for Down's syndrome (integrated test, sequential screening, and contingent screenings) and to determine the most useful cut-off values for risk. Computer simulations to study integrated, sequential, and contingent screening strategies with various cut-offs leading to 19 potential screening algorithms. The computer simulation was populated with data from the Serum Urine and Ultrasound Screening Study (SURUSS), real unit costs for healthcare interventions, and a population of 110 948 pregnancies from the province of Québec for the year 2001. Cost effectiveness ratios, incremental cost effectiveness ratios, and screening options' outcomes. The contingent screening strategy dominated all other screening options: it had the best cost effectiveness ratio ($C26,833 per case of Down's syndrome) with fewer procedure related euploid miscarriages and unnecessary terminations (respectively, 6 and 16 per 100,000 pregnancies). It also outperformed serum screening at the second trimester. In terms of the incremental cost effectiveness ratio, contingent screening was still dominant: compared with screening based on maternal age alone, the savings were $C30,963 per additional birth with Down's syndrome averted. Contingent screening was the only screening strategy that offered early reassurance to the majority of women (77.81%) in first trimester and minimised costs by limiting retesting during the second trimester (21.05%). For the contingent and sequential screening strategies, the choice of cut-off value for risk in the first trimester test significantly affected the cost effectiveness ratios (respectively, from $C26,833 to $C37,260 and from $C35,215 to $C45,314 per case of Down's syndrome), the number of procedure related euploid miscarriages (from 6 to 46 and from 6 to 45 per 100,000 pregnancies), and the number of unnecessary terminations (from 16 to 26 and from 16 to 25 per 100

  14. Safe current injection strategies for a STATCOM under asymmetrical grid faults

    DEFF Research Database (Denmark)

    Rodriguez, Pedro; Medeiros, Gustavo; Luna, Alvaro

    2010-01-01

    This paper explores different strategies to set the reference current of a STATCOM under unbalanced grid voltage conditions and determines the maximum deliverable reactive power in each case to guarantee the injected current is permanently within the STATCOM secure operation limits. The paper...... presents a comprehensive derivation of the proposed STATCOM control strategies to set the reactive current reference under unbalanced grid faults, together with an extensive evaluation using simulation and experimental results from a low-scale laboratory setup in order to verify and validate the dynamic...

  15. Pharmacoeconomic analysis of conservative strategy for the treatment of patients with diabetic foot syndrome in Moscow

    Directory of Open Access Journals (Sweden)

    Marina Fedorovna Kalashnikova

    2011-09-01

    Full Text Available Aim. To perform cost-effectiveness analysis of prescription of pharmaceutical products and dressing materials and their consumption volume for inandout-patient treatment of diabetic foot syndrome (DFS. To analyse efficacy of the treatment in terms of modern therapeutic standards. Materials and methods. This retrospective study is based on the medical documentation of 139 DM1 and DM2 patients with DFS from differentmedical facilities of Moscow (2007. 72 patients were given general out-patient care by surgeons of city polyclinics, 50 ones received specialized aidin the regional Diabetic Foot Cabinet. 67 patients were hospitalized: 20 for general care in the department of purulent surgery of a military hospital,27 for specialized care in the department of purulent surgery of a city hospital, 20 for high-technology care in the endocrinological clinic of the FirstMoscow State Medical University. Results. Therapeutic strategy for DFS patients used in the regional Diabetic Foot Cabinet met the current therapeutic standards. General out-patientcare by surgeons of city polyclinics was at variance with the algorithms adopted in this country. Pharmacoeconomic analysis of the spectrum of pharmaceuticalproducts used for in- and out-patient treatment of DFS patients revealed frequent and ungrounded application of drugs whose woundhealing effect remains to be confirmed (pentoxifylline, thioctoic and alpha-lipoic acids. Conclusion. Additional training courses for surgeons of Moscow polyclinics are needed to improve the quality of medical aid to DFS patients. Suchpatients must be referred to regional Diabetic Foot Cabinets. Pentoxifylline, thioctoic and alpha-lipoic acids need to be substituted by pharmaceuticalswith validated therapeutic efficacy.

  16. Burnout syndrome and coping strategies in Portuguese oncology health care providers

    Directory of Open Access Journals (Sweden)

    VASCO F. J. CUMBE

    Full Text Available Abstract Background Burnout is a multidimensional syndrome and includes symptoms of emotional exhaustion, depersonalization, and reduced personal accomplishment at work. Oncology health care providers are at high risk to develop symptoms of burnout because of work-related stressors. Adaptive coping strategies adopted to deal with stressors may prevent the development of burnout. Objective The present study aims to assess the association between burnout, functional coping strategies, and occupational factors in a sample of oncology providers, mostly nurses. Methods Sociodemographic Questionnaire, the Maslach Burnout Inventory, and the Problem Solving Inventory “Inventário de Resolução de Problemas” were administered. Descriptive, correlational, and linear regression analyses were performed. Results The study showed that emotional exhaustion correlated with lower levels of adaptive coping, less years of experience in Oncology, and a greater amount of hours worked per week. Personal accomplishment was associated with the adaptive coping strategies. No further statistically significant associations were identified. Discussion Our findings support the importance of adaptive coping strategies in order to prevent symptoms of burnout when health professionals face potentially stressful occupational factors. Training aimed at improving adaptive coping skills may prevent burnout syndrome for health care professionals working in Oncology.

  17. USHER SYNDROME IN EDUCATIONAL SETTINGS: INDIGENOUS IDENTIFICATION STRATEGIES DEVELOPED IN INDIA

    Directory of Open Access Journals (Sweden)

    Gnanathicam Victoria NAOMI

    2013-09-01

    Full Text Available Introduction:most teachers of hearing and visually impaired children in India have to learn more about the prevalence and characteristics of Usher Syndrome. Keeping in mind the need to address this neglected population, the present study was designed and executed in South India.Goals:the goals of the study were to identify students with Usher Syndrome in educational settings using indigenous techniques, and to develop and describe a protocol for identifying these students.Methodology:seven hundred hearing impaired students studying in residential and inclusive schools in four districts of the State Tamil Nadu were screened using tools which included screening for distance and near vision, field of vision, dark adaptation, glare and contrast sensitivity.Results:ten students between the age of 14- 20 were found to be at risk of having Usher Syndrome. Finally, 6 subjects who had a diagnosis of retinitis pigmentosa were clinically identified with Usher Syndrome.Conclusion:these identification strategies will assist special education and rehabilitation pro­fess­ionals in recognizing symptoms of Usher Synd­rome so that they will be able to refer these children for diagnostic and supportive services.

  18. Metabolic syndrome in subjects with bipolar disorder and major depressive disorder in a current depressive episode: Population-based study: Metabolic syndrome in current depressive episode.

    Science.gov (United States)

    Moreira, Fernanda Pedrotti; Jansen, Karen; Cardoso, Taiane de Azevedo; Mondin, Thaíse Campos; Magalhães, Pedro Vieira da Silva; Kapczinski, Flávio; Souza, Luciano Dias de Mattos; da Silva, Ricardo Azevedo; Oses, Jean Pierre; Wiener, Carolina David

    2017-09-01

    To assess the differences in the prevalence of the metabolic syndrome (MetS) and their components in young adults with bipolar disorder (BD) and major depressive disorder (MDD) in a current depressive episode. This was a cross-sectional study with young adults aged 24-30 years old. Depressive episode (bipolar or unipolar) was assessed using the Mini International Neuropsychiatric Interview - Plus version (MINI Plus). The MetS was assessed using the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III). The sample included 972 subjects with a mean age of 25.81 (±2.17) years. Both BD and MDD patients showed higher prevalence of MetS compared to the population sample (BD = 46.9%, MDD = 35.1%, population = 22.1%, p depressive episode compared to the general population. Moreover, there was a significant difference on BMI values in the case of BD and MDD subjects (p = 0.016). Metabolic components were significantly associated with the presence of depressive symptoms, independently of the diagnosis. Copyright © 2017. Published by Elsevier Ltd.

  19. Imaging in syndrome complex diabetes mellitus. Current standards and future perspectives

    International Nuclear Information System (INIS)

    Hetterich, H.; Schafnitzel, A.; Bamberg, F.

    2015-01-01

    Diabetes mellitus is a highly prevalent multisystemic disorder with numerous potential complications and substantial socioeconomic consequences. In many cases, the patient history, physical examination and laboratory tests are not sufficient for a comprehensive evaluation of complicating disorders. Imaging modalities, such as sonography, computed tomography (CT) and magnetic resonance imaging (MRI) are of major significance in the evaluation of complicating disorders of diabetes according to current guidelines. Examples include assessment of coronary artery disease, peripheral artery disease, stroke and diabetic foot syndrome. Technical developments allow a substantial reduction in radiation dose and scan time in CT and MRI, respectively and could therefore justify a broader application in this patient population. In the future CT and MRI could also be used for the early detection of diabetic complications. Furthermore, they could also be used for risk stratification, e.g. measurement of hepatic fat content and evaluation of atherosclerosis in whole body MRI. Prior to widespread application of advanced imaging techniques in this patient population, improved outcomes with respect to survival, quality of life and cost-effectiveness need to be demonstrated. Diagnostic imaging modalities for the evaluation of the syndrome complex of diabetic disorders should be used according to the current guidelines but the use is predicted to increase given the high potential in this population. (orig.) [de

  20. Current views on neurostimulation in the treatment of cardiac ischemic syndromes.

    Science.gov (United States)

    Jessurun, G A; DeJongste, M J; Blanksma, P K

    1996-08-01

    Most clinicians are still unacquainted with the beneficial effects of neurostimulation as an additional therapeutic strategy for severe angina pectoris. Patients with therapeutically refractory angina pectoris suffer from chest discomfort during minimal exercise, despite maximal tolerated antianginal drug therapy (at least 2 out of a beta-blocker, calcium-antagonist or long-acting nitrate). In these patients, revascularization procedures, such as a percutaneous transluminal coronary angioplasty or coronary artery bypass surgery, are often technically impossible because of diffuse coronary artery disease or should be withheld as a consequence of absolute contraindications such as severe left ventricular dysfunction. All patients have inoperable multivessel disease, experienced one or more myocardial infarctions, and were treated by earlier invasive interventions. This group of patients are severely physically and psychologically disabled by their intractable angina pectoris. Available published data and the neurostimulation experience of the authors are reviewed in relation to the treatment of cardiac ischemic syndromes. We conclude that neurostimulation is an effective therapeutic adjuvant for patients with severe angina pectoris unresponsive to standard treatment. This treatment modality appears to be safe, and a promising tool for other ischemic cardiac syndromes.

  1. Fowl adenovirus-induced diseases and strategies for their control - a review on the current global situation.

    Science.gov (United States)

    Schachner, Anna; Matos, Miguel; Grafl, Beatrice; Hess, Michael

    2018-04-01

    The stand-alone pathogenicity of fowl adenoviruses (FAdVs) had long been disputed, given the ubiquity of the viruses versus sporadic outbreaks, and variation between experimental studies. However, a globally emerging trend of FAdV-associated diseases has marked the past two decades, with hepatitis-hydropericardium syndrome mainly in Asia besides Arabian and Latin American countries, and geographically more disseminated outbreaks of inclusion body hepatitis. Finally, the appearance of FAdV-induced gizzard erosion (AGE) in Asia and Europe completed the range of diseases. Epidemiological studies confirmed serotype FAdV-4 as agent of hepatitis-hydropericardium syndrome, whereas inclusion body hepatitis is related to FAdV-2, -8a, -8b and -11. Members of the biologically more distant serotype FAdV-1 induce AGE. Urged by increasing problems in the field, numerous pathogenicity studies with FAdVs from outbreaks substantiated the primary aetiologic role of particular strains for distinct clinical conditions. Developments in the poultry industry towards highly specialized genetic breeds and rigorous biosecurity additionally contribute to the growing incidence of FAdV-related diseases. Confirming field observations, recent studies connected a higher susceptibility of broilers with their distinct physiology, implying the choice of bird type as a factor to be considered in infection studies. Furthermore, elevated biosecurity standards have generated immunologically naïve breeding stocks, putting broilers at risk in face of vertical FAdV transmission. Therefore, future prevention strategies should include adequate antibodies in breeders prior to production and - if necessary - vaccination, in order to protect progenies. This review aims to deliver a detailed overview on the current global situation about FAdV-induced diseases, their reproduction in vivo and vaccination strategies.

  2. A DC Microgrid Coordinated Control Strategy Based on Integrator Current-Sharing

    Directory of Open Access Journals (Sweden)

    Liyuan Gao

    2017-08-01

    Full Text Available The DC microgrid has become a new trend for microgrid study with the advantages of high reliability, simple control and low losses. With regard to the drawbacks of the traditional droop control strategies, an improved DC droop control strategy based on integrator current-sharing is introduced. In the strategy, the principle of eliminating deviation through an integrator is used, constructing the current-sharing term in order to make the power-sharing between different distributed generation (DG units uniform and reasonable, which can reduce the circulating current between DG units. Furthermore, at the system coordinated control level, a hierarchical/droop control strategy based on the DC bus voltage is proposed. In the strategy, the operation modes of the AC main network and micro-sources are determined through detecting the DC voltage variation, which can ensure the power balance of the DC microgrid under different operating conditions. Meanwhile, communication is not needed between different DG units, while each DG unit needs to sample the DC bus voltage, which retains the plug-and-play feature of the DC microgrid. The proposed control strategy is validated by simulation on a DC microgrid with permanent magnet synchronous generator-based wind turbines, solar arrays and energy storage batteries, which can be applied to small commercial or residential buildings.

  3. [Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].

    Science.gov (United States)

    Baeza Román, Anna; Latour Pérez, Jaime; de Miguel Balsa, Eva; Pino Izquierdo, Karel; Coves Orts, Francisco Javier; García Ochando, Luis; de la Torre Fernández, Maria José

    2014-05-20

    In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy. Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression. We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel. The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  4. Invasive strategies and outcomes for non-ST-segment elevation acute coronary syndromes: a twelve-year experience from SWEDEHEART

    NARCIS (Netherlands)

    Damman, Peter; Jernberg, Tomas; Lindahl, Bertil; de Winter, Robbert J.; Jeppsson, Anders; Johanson, Per; Held, Claes; James, Stefan K.

    2016-01-01

    Despite recommendations in recent guidelines for a routine invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS), long-term data on the implementation of treatment strategies in clinical practice are not available. Our aim was to provide long-term data on the

  5. Current insights in sepsis: from pathogenesis to new treatment targets

    NARCIS (Netherlands)

    Wiersinga, W. Joost

    2011-01-01

    Sepsis continues to be a leading cause of ICU death. This review summarizes current knowledge on sepsis pathogenesis and new therapeutical strategies. Although systemic inflammatory response syndrome predominates in early sepsis, the compensatory anti-inflammatory response syndrome causes

  6. Job monitoring on the WLCG scope: Current status and new strategy

    International Nuclear Information System (INIS)

    Andreeva, Julia; Casey, James; Gaidioz, Benjamin; Karavakis, Edward; Kokoszkiewicz, Lukasz; Lanciotti, Elisa; Maier, Gerhild; Rodrigues, Daniele Filipe Rocha Da Cuhna; Rocha, Ricardo; Saiz, Pablo; Sidorova, Irina; Boehm, Max; Belov, Sergey; Tikhonenko, Elena; Dvorak, Frantisek; Krenek, Ales; Mulac, Milas; Sitera, Jiri; Kodolova, Olga; Vaibhav, Kumar

    2010-01-01

    Job processing and data transfer are the main computing activities on the WLCG infrastructure. Reliable monitoring of the job processing on the WLCG scope is a complicated task due to the complexity of the infrastructure itself and the diversity of the currently used job submission methods. The paper will describe current status and the new strategy for the job monitoring on the WLCG scope, covering primary information sources, job status changes publishing, transport mechanism and visualization.

  7. Currents issues in cardiorespiratory care of patients with post-polio syndrome

    Directory of Open Access Journals (Sweden)

    Marco Orsini

    2016-07-01

    Full Text Available ABSTRACT Post-polio syndrome (PPS is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

  8. Current diagnostics and treatment of the cubital tunnel syndrome in Austria

    Directory of Open Access Journals (Sweden)

    Harder, Kristina

    2016-01-01

    Full Text Available According to the vote of the Austrian Society for Surgery of the Hand (ÖGH an investigation to collect data on the current state of the treatment of cubital tunnel syndrome was initiated. Over one year a total of 875 patients with cubital tunnel syndrome were operated in Austria, this means an incidence of this nerve entrapment of 0.011%. Most of the operations were done by trauma surgeons (287; 33%. For diagnosis most of the centers rely on clinical symptoms, electroneurophysiology, and elbow X-ray. 40% of the institutions regard conservative therapy as useless and not indicated. If conservative treatment modalities are applied, physiotherapy (97%, non-steroidal anti-inflammatory medication (77%, and glucocorticoid injections (30% are primarily used. In case of simple nerve entrapment most of the surgeons (72% prefer simple nerve decompression. If there is additional pathology subcutaneous cubital nerve transposition is recommended (62%. Endoscopic techniques are only use by 3% of the surgeons. In the postoperative care, physiotherapy is favored in 51%, whereas 24% do not judge any postoperative care as beneficial.The three most often encountered complications were incomplete remission, scar contracture and hypertrophy, and postoperative bleeding.

  9. A Coordinate Control Strategy for Circulating Current Suppression in Multiparalleled Three-Phase Inverters

    DEFF Research Database (Denmark)

    Zhang, Xueguang; Wang, Tianyi; Wang, Xiongfei

    2017-01-01

    This paper addresses the zero-sequence circulating current control in the multiparalleled three-phase voltage-source inverters. The model of the zero-sequence circulating current in the N-paralleled (N ≥ 3) inverters is derived. It is shown that the circulating current is not only susceptible...... to the mismatches of circuit parameters, but it is also influenced by the interactions of circulating current controllers used by other paralleled inverters. To eliminate these adverse effects on the circulating current control loop, a coordinate control strategy for the N-paralleled inverter is proposed based...... on the zero-vector feedforward method with the space-vector pulse width modulation. Moreover, a virtual inverter method is introduced to facilitate the implementation of the proposed controller, which decouples the interactions of circulating current controllers in the paralleled inverters. Finally...

  10. Delivering Communication Strategy Training for People with Aphasia: What Is Current Clinical Practice?

    Science.gov (United States)

    Beckley, Firle; Best, Wendy; Beeke, Suzanne

    2017-01-01

    Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…

  11. Parent Retrospective Recollections of Bullying and Current Views, Concerns, and Strategies to Cope with Children's Bullying

    Science.gov (United States)

    Cooper, Leigh A.; Nickerson, Amanda B.

    2013-01-01

    In this study, parent history of bullying was examined in terms of general involvement with bullying, specific types of bullying experienced, level of hurtfulness associated with the experience, and when bullying occurred. Parent current views, levels of concern, and strategies used to cope with bullying were also evaluated. Finally, the…

  12. Modelling the transport system in China and evaluating the current strategies towards the sustainable transport development

    DEFF Research Database (Denmark)

    Liu, W.; Lund, H.; Mathiesen, B.V.

    2013-01-01

    in China. With this purpose in mind, a Chinese transport model has been created and three current transport strategies which are high speed railway (HSR), urban rail transit (URT) and electric vehicle (EV) were evaluated together with a reference transport system in 2020. As conservative results, 13...

  13. Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis Syndrome: Current Literature Review with a Case Report

    Directory of Open Access Journals (Sweden)

    Mahmut Demirtaş

    2018-04-01

    Full Text Available Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Adenitis syndrome (PFAPA is a frequently seen, important medical condition, which must be kept in mind in periodic fever etiology. Although its etiology is not clearly understood, autoimmune etiology is suspected due to response to steroids. There is no specific test for the diagnosis of disease. Diagnosis is based on symptoms and physical examination. Although medical treatment is the first choice for the management of the disease, tonsillectomy take over in treatment options for termination of attacks and permanent results. We have presented a patient that was performed tonsillectomy in our clinic for frequent attacks despite recurrent medical therapy with diagnosis of PFAPA with review of current literature.

  14. Chemical and molecular factors in irritable bowel syndrome: current knowledge, challenges, and unanswered questions.

    Science.gov (United States)

    Camilleri, Michael; Oduyebo, Ibironke; Halawi, Houssam

    2016-11-01

    Several chemical and molecular factors in the intestine are reported to be altered and to have a potentially significant role in irritable bowel syndrome (IBS), particularly in IBS with diarrhea. These include bile acids; short-chain fatty acids; mucosal barrier proteins; mast cell products such as histamine, proteases, and tryptase; enteroendocrine cell products; and mucosal mRNAs, proteins, and microRNAs. This article reviews the current knowledge and unanswered questions in the pathobiology of the chemical and molecular factors in IBS. Evidence continues to point to significant roles in pathogenesis of these chemical and molecular mechanisms, which may therefore constitute potential targets for future research and therapy. However, it is still necessary to address the interaction between these factors in the gut and to appraise how they may influence hypervigilance in the central nervous system in patients with IBS. Copyright © 2016 the American Physiological Society.

  15. Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative.

    Science.gov (United States)

    Wai, A; Pulver, L K; Oliver, K; Thompson, A

    2012-05-01

    Evidence-practice gaps exist in the continuum of care for patients with acute coronary syndromes (ACS), particularly at hospital discharge. We aimed to describe the methodology and baseline results of the Discharge Management of Acute Coronary Syndromes (DMACS) project, focusing on the prescription of guideline-recommended medications, referral to cardiac rehabilitation and communication between the hospital, patient and their primary healthcare professionals. DMACS employed Drug Use Evaluation methodology involving data collection, evaluation and feedback, and targeted educational interventions. Adult patients with ACS discharged during a 4-month period were eligible to participate. Data were collected (maximum 50 patients) at each site through an inpatient medical record review, a general practitioner (GP) postal/fax survey conducted 14 days post discharge and a patient telephone survey 3 months post discharge. Forty-nine hospitals participated in the audit recruiting 1545 patients. At discharge, 57% of patients were prescribed a combination of antiplatelet agent(s), beta-blocker, statin and angiotensin-converting enzyme inhibitor and/or angiotensin II-antagonist. At 3 months post discharge, 48% of patients reported using the same combination. Some 67% of patients recalled being referred to cardiac rehabilitation; of these, 33% had completed the programme. In total, 83% of patients had a documented ACS management plan at discharge. Of these, 90% included a medication list, 56% a chest pain action plan and 54% risk factor modification advice. Overall, 65% of GPs rated the quality of information received in the discharge summary as 'very good' to 'excellent'. The findings of our baseline audit showed that despite the robust evidence base and availability of national guidelines, the management of patients with ACS can be improved. These findings will inform a multifaceted intervention strategy to improve adherence to guidelines for the discharge management of

  16. A fault-tolerant strategy based on SMC for current-controlled converters

    Science.gov (United States)

    Azer, Peter M.; Marei, Mostafa I.; Sattar, Ahmed A.

    2018-05-01

    The sliding mode control (SMC) is used to control variable structure systems such as power electronics converters. This paper presents a fault-tolerant strategy based on the SMC for current-controlled AC-DC converters. The proposed SMC is based on three sliding surfaces for the three legs of the AC-DC converter. Two sliding surfaces are assigned to control the phase currents since the input three-phase currents are balanced. Hence, the third sliding surface is considered as an extra degree of freedom which is utilised to control the neutral voltage. This action is utilised to enhance the performance of the converter during open-switch faults. The proposed fault-tolerant strategy is based on allocating the sliding surface of the faulty leg to control the neutral voltage. Consequently, the current waveform is improved. The behaviour of the current-controlled converter during different types of open-switch faults is analysed. Double switch faults include three cases: two upper switch fault; upper and lower switch fault at different legs; and two switches of the same leg. The dynamic performance of the proposed system is evaluated during healthy and open-switch fault operations. Simulation results exhibit the various merits of the proposed SMC-based fault-tolerant strategy.

  17. Current thoughts on maternal nutrition and fetal programming of the metabolic syndrome.

    Science.gov (United States)

    Brenseke, Bonnie; Prater, M Renee; Bahamonde, Javiera; Gutierrez, J Claudio

    2013-01-01

    Chronic diseases such as type 2 diabetes and cardiovascular disease are the leading cause of death and disability worldwide. Although the metabolic syndrome has been defined in various ways, the ultimate importance of recognizing this combination of disorders is that it helps identify individuals at high risk for both type 2 diabetes and cardiovascular disease. Evidence from observational and experimental studies links adverse exposures in early life, particularly relating to nutrition, to chronic disease susceptibility in adulthood. Such studies provide the foundation and framework for the relatively new field of developmental origins of health and disease (DOHaD). Although great strides have been made in identifying the putative concepts and mechanisms relating specific exposures in early life to the risk of developing chronic diseases in adulthood, a complete picture remains obscure. To date, the main focus of the field has been on perinatal undernutrition and specific nutrient deficiencies; however, the current global health crisis of overweight and obesity demands that perinatal overnutrition and specific nutrient excesses be examined. This paper assembles current thoughts on the concepts and mechanisms behind the DOHaD as they relate to maternal nutrition, and highlights specific contributions made by macro- and micronutrients.

  18. Current Thoughts on Maternal Nutrition and Fetal Programming of the Metabolic Syndrome

    Directory of Open Access Journals (Sweden)

    Bonnie Brenseke

    2013-01-01

    Full Text Available Chronic diseases such as type 2 diabetes and cardiovascular disease are the leading cause of death and disability worldwide. Although the metabolic syndrome has been defined in various ways, the ultimate importance of recognizing this combination of disorders is that it helps identify individuals at high risk for both type 2 diabetes and cardiovascular disease. Evidence from observational and experimental studies links adverse exposures in early life, particularly relating to nutrition, to chronic disease susceptibility in adulthood. Such studies provide the foundation and framework for the relatively new field of developmental origins of health and disease (DOHaD. Although great strides have been made in identifying the putative concepts and mechanisms relating specific exposures in early life to the risk of developing chronic diseases in adulthood, a complete picture remains obscure. To date, the main focus of the field has been on perinatal undernutrition and specific nutrient deficiencies; however, the current global health crisis of overweight and obesity demands that perinatal overnutrition and specific nutrient excesses be examined. This paper assembles current thoughts on the concepts and mechanisms behind the DOHaD as they relate to maternal nutrition, and highlights specific contributions made by macro- and micronutrients.

  19. Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome.

    Science.gov (United States)

    Grosman-Rimon, Liza; Clarke, Hance; Chan, Aaron K; Mills, Patricia Branco; Rathbone, Alasdair Timothy Llewelyn; Kumbhare, Dinesh

    2017-01-01

    Myofascial pain syndrome (MPS) is one of the most common chronic musculoskeletal pain disorders. However, MPS is often under-diagnosed. The purpose of this study was to characterize practicing clinicians' perspectives of the current diagnostic criteria for MPS. A cross-sectional study design was used with a self-administered questionnaire. The questionnaire evaluated clinicians' perspective of the current diagnostic criteria for MPS. The sample population (n= 119) consisted of 40% family physicians, 31% physical medicine (PM) and rehabilitation specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. Our findings demonstrated that participating clinicians agree that ``point tenderness'' and ``pain reproduction'' are criteria for MPS. In contrast, the clinicians do not consider ``autonomic symptoms'' as an important criterion for MPS. The anesthesiologists view ``restricted range of motion'' as a criterion for MPS more than the other groups, and they tend to consider ``referred pain'' and ``pain reproduction'' as criteria. Physical medicine and rehabilitation specialists and anesthesiologists tend to view ``local twitch response'' more as a criterion for MPS compared with the other groups. Most groups of clinicians consider ``weakness without atrophy'' as an important MPS criterion except for family physicians. It is important to note that ``poor sleep'', ``daytime fatigue'' and ``cognitive symptoms'', which are not considered as MPS symptoms, are often mistaken for MPS among practicing clinicians. Our findings suggest that the diagnostic criteria are not well known, highlighting the need for an expert consensus to determine the importance of each criterion for MPS diagnosis.

  20. Strategies of bringing drug product marketing applications to meet current regulatory standards.

    Science.gov (United States)

    Wu, Yan; Freed, Anita; Lavrich, David; Raghavachari, Ramesh; Huynh-Ba, Kim; Shah, Ketan; Alasandro, Mark

    2015-08-01

    In the past decade, many guidance documents have been issued through collaboration of global organizations and regulatory authorities. Most of these are applicable to new products, but there is a risk that currently marketed products will not meet the new compliance standards during audits and inspections while companies continue to make changes through the product life cycle for continuous improvement or market demands. This discussion presents different strategies to bringing drug product marketing applications to meet current and emerging standards. It also discusses stability and method designs to meet process validation and global development efforts.

  1. Current challenges and emerging drug delivery strategies for the treatment of psoriasis.

    Science.gov (United States)

    Hoffman, Melissa B; Hill, Dane; Feldman, Steven R

    2016-10-01

    Psoriasis is a common skin disorder associated with physical, social, psychological and financial burden. Over the past two decades, advances in our understanding of pathogenesis and increased appreciation for the multifaceted burden of psoriasis has led to new treatment development and better patient outcomes. Yet, surveys demonstrate that many psoriasis patients are either undertreated or are dissatisfied with treatment. There are many barriers that need be overcome to optimize patient outcomes and satisfaction. This review covers the current challenges associated with each major psoriasis treatment strategy (topical, phototherapy, oral medications and biologics). It also reviews the challenges associated with the psychosocial aspects of the disease and how they affect treatment outcomes. Patient adherence, inconvenience, high costs, and drug toxicities are all discussed. Then, we review the emerging drug delivery strategies in topical, oral, and biologic therapy. By outlining current treatment challenges and emerging drug delivery strategies, we hope to highlight the deficits in psoriasis treatment and strategies for how to overcome them. Regardless of disease severity, clinicians should use a patient-centered approach. In all cases, we need to balance patients' psychosocial needs, treatment costs, convenience, and effectiveness with patients' preferences in order to optimize treatment outcomes.

  2. Modelling the transport system in China and evaluating the current strategies towards the sustainable transport development

    International Nuclear Information System (INIS)

    Liu, Wen; Lund, Henrik; Mathiesen, Brian Vad

    2013-01-01

    Transport is one of the most challenge sectors when addressing energy security and climate change due to its high reliance on oil products and lack of the alternative fuels. This paper explores the ability of three transport strategies to contribute to the development of a sustainable transport in China. With this purpose in mind, a Chinese transport model has been created and three current transport strategies which are high speed railway (HSR), urban rail transit (URT) and electric vehicle (EV) were evaluated together with a reference transport system in 2020. As conservative results, 13% of the energy saving and 12% of the CO 2 emission reduction can be attained by accomplishing three strategies compared with the reference transport system. However, the energy demand of transport in 2020 with the implementation of three strategies will be about 1.7 times as much as today. The three strategies show the potential of drawing the transport demand to the more energy efficient vehicles; however, more initiatives are needed if the sustainable transport is the long term objective, such as the solutions to stabilise the private vehicle demands, to continuously improve the vehicle efficiency and to boost the alternative fuels produced from the renewable energy sources. - Highlights: • A Chinese transport model was created and three transport strategies were evaluated • Transport is the biggest driver of the oil demand in China not the industry • The energy demand of transport in 2020 will be twice as much as today • Strategies contribute 13% energy saving and 12% CO 2 emission reduction • More initiatives are needed if a sustainable transport is the long-term objective

  3. Dose reduction in spiral CT angiography of thoracic outlet syndrome by anatomically adapted tube current modulation

    International Nuclear Information System (INIS)

    Mastora, I.; Remy-Jardin, M.; Remy, J.; Suess, C.; Scherf, C.; Guillot, J.P.

    2001-01-01

    The aim of this study was to evaluate dose reduction in spiral CT angiography of the thoracic outlet by on-line tube-current control. Prospectively, 114 patients undergoing spiral CT angiography of the subclavian artery for thoracic outlet arterial syndromes were evaluated with and without tube-current modulation at the same session (scanning parameters for the two successive angiograms, one in the neutral position and one after the postural maneuver): 140 kV; 206 mA; scan time 0.75 s; collimation 3 mm; pitch = (1). The dose reduction system was applied in the neutral position in the first 92 consecutive patients and after postural maneuver in the remaining 22 consecutive patients. Dose reduction and image quality were analyzed in the overall study group (group 1; n = 114). The influence of the arm position was assessed in 44 of the 114 patients (group 2), matched by the transverse diameter of the upper thorax. The mean dose reduction was 33 % in group 1 (range 22-40 %) and 34 % in group 2 (range 26-40 %). In group 2 the only difference in image quality was a significantly higher frequency of graininess on low-dose scans compared with reference scans whatever the patient's arm position, graded as minimal in 38 of the 44 patients (86 %). When the low-dose technique was applied after postural maneuver in group 2: (a) the mean dose reduction was significantly higher (35 vs 32 % in the neutral position; p = 0.006); (b) graininess was less frequent (82 vs 91 % in the neutral position); and (c) the percentage of graininess graded as minimal was significantly higher (83 vs 70 % in the neutral position; p = 0.2027). On-line tube-current modulation enables dose reduction on high-quality, diagnostic spiral CT angiograms of the thoracic outlet and should be applied during data acquisition in the neutral position and after postural maneuver for optimal use. (orig.)

  4. Dose reduction in spiral CT angiography of thoracic outlet syndrome by anatomically adapted tube current modulation

    Energy Technology Data Exchange (ETDEWEB)

    Mastora, I.; Remy-Jardin, M.; Remy, J. [Dept. of Radiology, University Center Hospital Calmette, Lille (France); Medical Research Group, Lille (France); Suess, C.; Scherf, C. [Siemens Medical Systems, Forcheim (Germany); Guillot, J.P. [Dept. of Radiology, University Center Hospital Calmette, Lille (France)

    2001-04-01

    The aim of this study was to evaluate dose reduction in spiral CT angiography of the thoracic outlet by on-line tube-current control. Prospectively, 114 patients undergoing spiral CT angiography of the subclavian artery for thoracic outlet arterial syndromes were evaluated with and without tube-current modulation at the same session (scanning parameters for the two successive angiograms, one in the neutral position and one after the postural maneuver): 140 kV; 206 mA; scan time 0.75 s; collimation 3 mm; pitch = (1). The dose reduction system was applied in the neutral position in the first 92 consecutive patients and after postural maneuver in the remaining 22 consecutive patients. Dose reduction and image quality were analyzed in the overall study group (group 1; n = 114). The influence of the arm position was assessed in 44 of the 114 patients (group 2), matched by the transverse diameter of the upper thorax. The mean dose reduction was 33 % in group 1 (range 22-40 %) and 34 % in group 2 (range 26-40 %). In group 2 the only difference in image quality was a significantly higher frequency of graininess on low-dose scans compared with reference scans whatever the patient's arm position, graded as minimal in 38 of the 44 patients (86 %). When the low-dose technique was applied after postural maneuver in group 2: (a) the mean dose reduction was significantly higher (35 vs 32 % in the neutral position; p = 0.006); (b) graininess was less frequent (82 vs 91 % in the neutral position); and (c) the percentage of graininess graded as minimal was significantly higher (83 vs 70 % in the neutral position; p = 0.2027). On-line tube-current modulation enables dose reduction on high-quality, diagnostic spiral CT angiograms of the thoracic outlet and should be applied during data acquisition in the neutral position and after postural maneuver for optimal use. (orig.)

  5. Symptoms of Autism in Males with Fragile X Syndrome: A Comparison to Nonsyndromic ASD Using Current ADI-R Scores

    Science.gov (United States)

    McDuffie, Andrea; Thurman, Angela John; Hagerman, Randi J.; Abbeduto, Leonard

    2015-01-01

    Symptoms of autism are frequent in males with fragile X syndrome (FXS), but it is not clear whether symptom profiles differ from those of nonsyndromic ASD. Using individual item scores from the Autism Diagnostic Inventory-Revised, we examined which current symptoms of autism differed in boys with FXS relative to same-aged boys diagnosed with…

  6. BURNOUT SYNDROME IN NURSING STUDENTS BASED ON EFFECT OF STRESSOR, RELATIONAL MEANING AND COPING STRATEGY

    Directory of Open Access Journals (Sweden)

    Hilda Mazarina Devi

    2017-04-01

    Full Text Available Introduction: Professional education program is a program in which nursing students are transformed to become professional nurses. At this level, nursing students will encounter various stressors. The purpose of this study was to analyze the relationship between stressors, relational meaning and coping strategy on burnout syndrome in nursing students who are undergoing professional education. Method: This was a correlational study using cross-sectional approach. Population comprised regular student of nursing profession program at the Faculty of Nursing, Airlangga University. Sample size was determined by simple random sampling and 61 persons were included in the inclusion criteria. Data then analyzed using multiple linear regression test with signi fi cance level ofα < 0.05. Results: This study found that total burnout syndrome was signi fi cantly related to relational meaning (p = 0.005, β = 0.460. Emotional exhaustion was signi fi cantly related to relational meaning (p= 0.001, β = 0.532 and emotion focused coping (p = 0.035, β =0.298. Relational meaning was also signifi cantly related to depersonalization (p = 0.002, β = 0.050. Subsequently, the decline in self-achievement was signi fi cantly related to personal stressors, i.e the number of room mates (p = 0.016, β = 0.344, total learning time/day (p = 0.036, β=0.366 and environmental stressors (workload (p = 0.039, β = -0.349. Discussion: It is suggested for students to prepare for professional education, and the Faculty of Nursing, Airlangga University, should strengthen the function of academic counselors in terms of preceptorship role model in order to avoid the risk of burnout syndrome when the nursing students undergoing professional education.

  7. Neurotransmitter-based strategies for the treatment of cognitive dysfunction in Down syndrome.

    Science.gov (United States)

    Das, Devsmita; Phillips, Cristy; Hsieh, Wayne; Sumanth, Krithika; Dang, Van; Salehi, Ahmad

    2014-10-03

    Down syndrome (DS) is a multisystem disorder affecting the cardiovascular, respiratory, gastrointestinal, neurological, hematopoietic, and musculoskeletal systems and is characterized by significant cognitive disability and a possible common pathogenic mechanism with Alzheimer's disease. During the last decade, numerous studies have supported the notion that the triplication of specific genes on human chromosome 21 plays a significant role in cognitive dysfunction in DS. Here we reviewed studies in trisomic mouse models and humans, including children and adults with DS. In order to identify groups of genes that contribute to cognitive disability in DS, multiple mouse models of DS with segmental trisomy have been generated. Over-expression of these particular genes in DS can lead to dysfunction of several neurotransmitter systems. Therapeutic strategies for DS have either focused on normalizing the expression of triplicated genes with important roles in DS or restoring the function of these systems. Indeed, our extensive review of studies on the pathogenesis of DS suggests that one plausible strategy for the treatment of cognitive dysfunction is to target the cholinergic, serotonergic, GABA-ergic, glutamatergic, and norepinephrinergic system. However, a fundamental strategy for treatment of cognitive dysfunction in DS would include reducing to normal levels the expression of specific triplicated genes in affected systems before the onset of neurodegeneration. Published by Elsevier Inc.

  8. [Treatment of acute respiratory distress syndrome using pressure and volume controlled ventilation with lung protective strategy].

    Science.gov (United States)

    Ge, Ying; Wan, Yong; Wang, Da-qing; Su, Xiao-lin; Li, Jun-ying; Chen, Jing

    2004-07-01

    To investigate the significance and effect of pressure controlled ventilation (PCV) as well as volume controlled ventilation (VCV) by lung protective strategy on respiratory mechanics, blood gas analysis and hemodynamics in patients with acute respiratory distress syndrome (ARDS). Fifty patients with ARDS were randomly divided into PCV and VCV groups with permissive hypercapnia and open lung strategy. Changes in respiratory mechanics, blood gas analysis and hemodynamics were compared between two groups. Peak inspiration pressure (PIP) in PCV group was significantly lower than that in VCV group, while mean pressure of airway (MPaw) was significantly higher than that in VCV after 24 hours mechanical ventilation. After 24 hours mechanical ventilation, there were higher central venous pressure (CVP) and slower heart rate (HR) in two groups, CVP was significantly higher in VCV compared with PCV, and PCV group had slower HR than VCV group, the two groups had no differences in mean blood pressure (MBP) at various intervals. All patients showed no ventilator-induced lung injury. Arterial blood oxygenations were obviously improved in two groups after 24 hours mechanical ventilation, PCV group had better partial pressure of oxygen in artery (PaO2) than VCV group. Both PCV and VCV can improve arterial blood oxygenations, prevent ventilator-induced lung injury, and have less disturbance in hemodynamic parameters. PCV with lung protective ventilatory strategy should be early use for patients with ARDS.

  9. Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies.

    Science.gov (United States)

    Lapa, Teresa A; Madeira, Filipa M; Viana, Joaquim S; Pinto-Gouveia, José

    2017-02-01

    Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.

  10. Pulmonar recruitment in acute respiratory distress syndrome. What is the best strategy?

    Directory of Open Access Journals (Sweden)

    Cíntia Lourenço Santos

    Full Text Available Supporting patients with acute respiratory distress syndrome (ARDS, using a protective mechanical ventilation strategy characterized by low tidal volume and limitation of positive end-expiratory pressure (PEEP is a standard practice in the intensive care unit. However, these strategies can promote lung de-recruitment, leading to the cyclic closing and reopening of collapsed alveoli and small airways. Recruitment maneuvers (RM can be used to augment other methods, like positive end-expiratory pressure and positioning, to improve aerated lung volume. Clinical practice varies widely, and the optimal method and patient selection for recruitment maneuvers have not been determined, considerable uncertainty remaining regarding the appropriateness of RM. This review aims to discuss recent findings about the available types of RM, and compare the effectiveness, indications and adverse effects among them, as well as their impact on morbidity and mortality in ARDS patients. Recent developments include experimental and clinical evidence that a stepwise extended recruitment maneuver may cause an improvement in aerated lung volume and decrease the biological impact seen with the traditionally used sustained inflation, with less adverse effects. Prone positioning can reduce mortality in severe ARDS patients and may be an useful adjunct to recruitment maneuvers and advanced ventilatory strategies, such noisy ventilation and BIVENT, which have been useful in providing lung recruitment.

  11. Metabolic syndrome in Black people of the African diaspora: the paradox of current classification, definition and criteria.

    Science.gov (United States)

    Gaillard, Trudy; Schuster, Dara; Osei, Kwame

    2009-01-01

    According to the third National Health and Nutrition Examination Survey, African Americans have a lower prevalence of metabolic syndrome than do Whites. Recent reports in Blacks in other regions have confirmed these observations, but the rates vary. This lower rate of metabolic syndrome in Blacks can be partly ascribed to the lower prevalent rates of some major components of metabolic syndrome, namely serum triglyceride and high-density lipoprotein cholesterol levels in Blacks. This is in contrast with the higher prevalence of obesity (waist circumference) and blood pressure that meet National Cholesterol Education Program criteria in Blacks. Despite these seemingly favorable lipids and lipoprotein profiles, Blacks continue to have higher cardiovascular disease (CVD) mortality and morbidity, even in the absence of diabetes, than do Whites. Insulin resistance is more prevalent in Blacks than in Whites. However, the relationships among insulin resistance and CVD risk factors such as hypertension, high-density lipoprotein cholesterol, and triglycerides are weak in contrast with Whites. The paradox of more favorable lipid profile and conversely the higher rates of unfavorable blood pressure in Blacks calls into question the validity of the current criteria for metabolic syndrome in Blacks. Thus, it can be argued that each of the components of the metabolic syndrome carry different CVD risk factors in Blacks. The greater CVD mortality and morbidity in Blacks appear to be multifactorial. With the emerging epidemic of noncommunicable diseases, chronic kidney diseases due to both diabetes and hypertension have emerged as major CVD risks that are associated with increasing mortality and morbidity in Blacks. We need to emphasize specific components of metabolic syndrome, specifically blood pressure and chronic kidney disease, that carry higher CVD risk with associated greater morbidity and mortality for primary prevention of CVD and type 2 diabetes in Blacks. To this end, we

  12. Rapid Detection Strategies for the Global Threat of Zika Virus: Current State, New Hypotheses and Limitations

    Directory of Open Access Journals (Sweden)

    Shruti Shukla

    2016-10-01

    Full Text Available The current scenario regarding the widespread Zika virus (ZIKV has resulted in numerous diagnostic studies, specifically in South America and in locations where there is frequent entry of travelers returning from ZIKV-affected areas, including pregnant women with or without clinical symptoms of ZIKV infection. The World Health Organization, WHO, announced that millions of cases of ZIKV are likely to occur in the United States of America in the near future. This situation has created an alarming public health emergency of international concern requiring the detection of this life-threatening viral candidate due to increased cases of newborn microcephaly associated with ZIKV infection. Hence, this review reports possible methods and strategies for the fast and reliable detection of ZIKV with particular emphasis on current updates, knowledge and new hypotheses that might be helpful for medical professionals in poor and developing countries that urgently need to address this problem. In particular, we emphasize liposome-based biosensors. Although these biosensors are currently among the less popular tools for human disease detection, they have become useful tools for the screening and detection of pathogenic bacteria, fungi and viruses because of their versatile advantageous features compared to other sensing devices. This review summarizes the currently available methods employed for the rapid detection of ZIKV and suggests an innovative approach involving the application of a liposome-based hypothesis for the development of new strategies for ZIKV detection and their use as effective biomedicinal tools.

  13. A novel harmonic current sharing control strategy for parallel-connected inverters

    DEFF Research Database (Denmark)

    Guan, Yajuan; Guerrero, Josep M.; Savaghebi, Mehdi

    2017-01-01

    A novel control strategy which enables proportional linear and nonlinear loads sharing among paralleled inverters and voltage harmonic suppression is proposed in this paper. The proposed method is based on the autonomous currents sharing controller (ACSC) instead of conventional power droop control...... to provide fast transient response, decoupling control and large stability margin. The current components at different sequences and orders are decomposed by a multi-second-order generalized integrator-based frequency locked loop (MSOGI-FLL). A harmonic-orthogonal-virtual-resistances controller (HOVR......) is used to proportionally share current components at different sequences and orders independently among the paralleled inverters. Proportional resonance controllers tuned at selected frequencies are used to suppress voltage harmonics. Simulations based on two 2.2 kW paralleled three-phase inverters...

  14. Atypical Alstrom syndrome with novel ALMS1 mutations precluded by current diagnostic criteria.

    LENUS (Irish Health Repository)

    Casey, Jillian

    2014-02-01

    We report on clinical and genetic studies in a non-consanguineous Irish sib-pair with infantile dilated cardiomyopathy and retinopathy. A diagnosis of Alström Syndrome (AS) was considered and diagnostic testing pursued. The Alströms gene (ALMS1) is very large (23 exons) and diagnostic testing of mutational hotspots (exon 6, 8 and 10) was negative. Furthermore the siblings were tall and did not have the typical phenotype of nystagmus, photophobia, obesity or hearing loss and so the AS diagnosis was removed. We then sought to identify the causative gene in this family using whole exome sequencing. Unexpectedly, the exome analysis identified novel compound heterozygous ALMS1 mutations in exon 5 (c.777delT:p.D260fs*26) and exon 20 (c.12145_12146insC:p.S4049fs*36) that segregated with the phenotype. Although the siblings show some clinical overlap with AS, their phenotype is not classical. It is plausible that their atypical presentation may be due to the location of the ALMS1 mutations outside the usual mutational hotspots. Our findings show how atypical cases of AS may be missed under the current diagnostic guidelines and support consideration of complete ALMS1 sequencing in children with two or more features, even if all of the core clinical features of AS are not present.

  15. Prevalence and correlates of metabolic syndrome in pre-crisis Syria: call for current relief efforts.

    Science.gov (United States)

    Ramadan, H; Naja, F; Fouad, F M; Antoun, E; Jaffa, M; Chaaban, R; Haidar, M; Sibai, A M

    2016-12-12

    This study aimed to assess the prevalence, components and correlates of metabolic syndrome (MetS) in adults in pre-crisis Aleppo, Syrian Arab Republic. We used a population-based, 2-stage cluster sampling method in a population of 557 men and 611 women, randomly selected from 83 residential neighbourhoods including many rural settlers. Sociodemographic and lifestyle characteristics, comorbidity, anthropometry and biochemical indices were measured. Prevalence of MetS was estimated at 39.6%, with comparable rates in men and women. Hypertension was the most prevalent component (56.6%), followed by central obesity (51.4%). Among women, education (12 years) was inversely associated with risk of MetS, while family history of obesity and diabetes was associated with an increased risk. The high prevalence of MetS and its components emphasizes the burden of cardiovascular diseases among adults in pre-crisis Aleppo. A system of surveillance and management for cardiovascular diseases needs to be incorporated into the current humanitarian response.

  16. Current discharge management of acute coronary syndromes: data from the Rijnmond Collective Cardiology Research (CCR) study.

    Science.gov (United States)

    Yetgin, T; van der Linden, M M J M; de Vries, A G; Smits, P C; van Mechelen, R; Yap, S C; Boersma, E; Zijlstra, F; van Geuns, R-J M

    2014-01-01

    Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge. The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge. At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age. Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.

  17. Clinical Risk Assessment in the Antiphospholipid Syndrome: Current Landscape and Emerging Biomarkers.

    Science.gov (United States)

    Chaturvedi, Shruti; McCrae, Keith R

    2017-07-01

    Laboratory criteria for the classification of antiphospholipid syndrome include the detection of a lupus anticoagulant and/or anticardiolipin and anti-β2-glycoprotein I antibodies. However, the majority of patients who test positive in these assays do not have thrombosis. Current risk-stratification tools are largely limited to the antiphospholipid antibody profile and traditional thrombotic risk factors. Novel biomarkers that correlate with disease activity and potentially provide insight into future clinical events include domain 1 specific anti-β 2 GPI antibodies, antibodies to other phospholipids or phospholipid/protein antigens (such as anti-PS/PT), and functional/biological assays such as thrombin generation, complement activation, levels of circulating microparticles, and annexin A5 resistance. Clinical risk scores may also have value in predicting clinical events. Biomarkers that predict thrombosis risk in patients with antiphospholipid antibodies have been long sought, and several biomarkers have been proposed. Ultimately, integration of biomarkers with established assays and clinical characteristics may offer the best chance of identifying patients at highest risk of APS-related complications.

  18. Current Approaches and New Developments in the Pharmacological Management of Tourette Syndrome.

    Science.gov (United States)

    Quezada, Julio; Coffman, Keith A

    2018-01-01

    Tourette syndrome (TS) is a neurodevelopmental disorder of unknown etiology characterized by spontaneous, involuntary movements and vocalizations called tics. Once thought to be rare, TS affects 0.3-1% of the population. Tics can cause physical discomfort, emotional distress, social difficulties, and can interfere with education and desired activities. The pharmacologic treatment of TS is particularly challenging, as currently the genetics, neurophysiology, and neuropathology of this disorder are still largely unknown. However, clinical experience gained from treating TS has helped us better understand its pathogenesis and, as a result, derive treatment options. The strongest data exist for the antipsychotic agents, both typical and atypical, although their use is often limited in children and adolescents due to their side-effect profiles. There are agents in a variety of other pharmacologic categories that have evidence for the treatment of TS and whose side-effect profiles are more tolerable than the antipsychotics; these include clonidine, guanfacine, baclofen, topiramate, botulinum toxin A, tetrabenazine, and deutetrabenazine. A number of new agents are being developed and tested as potential treatments for TS. These include valbenazine, delta-9-tetrahydrocannabidiol, and ecopipam. Additionally, there are agents with insufficient data for efficacy, as well as agents that have been shown to be ineffective. Those without sufficient data for efficacy include clonazepam, ningdong granule, 5-ling granule, omega-3 fatty acids, and n-acetylcysteine. The agents that have been shown to be ineffective include pramipexole and metoclopramide. We will review all of the established pharmacologic treatments, and discuss those presently in development.

  19. Cost-Effectiveness Analysis of Different Genetic Testing Strategies for Lynch Syndrome in Taiwan.

    Directory of Open Access Journals (Sweden)

    Ying-Erh Chen

    Full Text Available Patients with Lynch syndrome (LS have a significantly increased risk of developing colorectal cancer (CRC and other cancers. Genetic screening for LS among patients with newly diagnosed CRC aims to identify mutations in the disease-causing genes (i.e., the DNA mismatch repair genes in the patients, to offer genetic testing for relatives of the patients with the mutations, and then to provide early prevention for the relatives with the mutations. Several genetic tests are available for LS, such as DNA sequencing for MMR genes and tumor testing using microsatellite instability and immunohistochemical analyses. Cost-effectiveness analyses of different genetic testing strategies for LS have been performed in several studies from different countries such as the US and Germany. However, a cost-effectiveness analysis for the testing has not yet been performed in Taiwan. In this study, we evaluated the cost-effectiveness of four genetic testing strategies for LS described in previous studies, while population-specific parameters, such as the mutation rates of the DNA mismatch repair genes and treatment costs for CRC in Taiwan, were used. The incremental cost-effectiveness ratios based on discounted life years gained due to genetic screening were calculated for the strategies relative to no screening and to the previous strategy. Using the World Health Organization standard, which was defined based on Taiwan's Gross Domestic Product per capita, the strategy based on immunohistochemistry as a genetic test followed by BRAF mutation testing was considered to be highly cost-effective relative to no screening. Our probabilistic sensitivity analysis results also suggest that the strategy has a probability of 0.939 of being cost-effective relative to no screening based on the commonly used threshold of $50,000 to determine cost-effectiveness. To the best of our knowledge, this is the first cost-effectiveness analysis for evaluating different genetic testing

  20. Zero-Axis Virtual Synchronous Coordinate Based Current Control Strategy for Grid-Connected Inverter

    Directory of Open Access Journals (Sweden)

    Longyue Yang

    2018-05-01

    Full Text Available Unbalanced power has a great influence on the safe and stable operation of the distribution network system. The static power compensator, which is essentially a grid-connected inverter, is an effective solution to the three-phase power imbalance problem. In order to solve the tracking error problem of zero-sequence AC current signals, a novel control strategy based on zero-axis virtual synchronous coordinates is proposed in this paper. By configuring the operation of filter transmission matrices, a specific orthogonal signal is obtained for zero-axis reconstruction. In addition, a controller design scheme based on this method is proposed. Compared with the traditional zero-axis direct control, this control strategy is equivalent to adding a frequency tuning module by the orthogonal signal generator. The control gain of an open loop system can be equivalently promoted through linear transformation. With its clear mathematical meaning, zero- sequence current control can be controlled with only a first-order linear controller. Through reasonable parameter design, zero steady-state error, fast response and strong stability can be achieved. Finally, the performance of the proposed control strategy is verified by both simulations and experiments.

  1. Old Disease and New Challenges: Major Obstacles of Current Strategies in the Prevention of Pertussis

    Science.gov (United States)

    Sedighi, Iraj; Karimi, Abdollah; Amanati, Ali

    2016-01-01

    Context Universal immunization against Bordetella pertussis has partially controlled the burden of the disease and its transmission. However, according to recent data, the epidemiology of this vaccine-preventable disease has changed. Now, younger infants, adolescents, and adults are at greater risk of infection. This article has studied the interaction between the various factors involved in the changing epidemiology of pertussis and the major obstacles faced by the current strategies in its prevention. Evidence Acquisition In this narrative review, the most recently published sources of information on pertussis control measures, consisting of textbooks and articles, have been reviewed. We focused on the more recent data about the changing epidemiology or pertussis in Scopus through the use of the MeSH-term words [pertussis] or [whooping cough] and [epidemiology] or [outbreak] or [resurgence], but our search was not restricted to this particular strategy; we also tried to find all of the most recent available data in the general field through other means. Results Primary and booster doses of the pertussis vaccine seem to partially control transmission of the disease, but despite the different preventive strategies available, pertussis continues to cause mortality and morbidity among high-risk groups. Conclusions Adding booster doses of acellular pertussis vaccine to the current national immunization practices with whole-cell vaccines for young adults and pregnant women seems to be a good option for controlling mortality and morbidity among high-risk groups such as very young infants. PMID:27729960

  2. Cost-effectiveness of early versus selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation

    NARCIS (Netherlands)

    Dijksman, L. M.; Hirsch, A.; Windhausen, F.; Asselman, F. F.; Tijssen, J. G. P.; Dijkgraaf, M. G. W.; de Winter, R. J.

    2009-01-01

    AIMS: The ICTUS trial compared an early invasive versus a selectively invasive strategy in high risk patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. Alongside the ICTUS trial a cost-effectiveness analysis from a provider perspective was performed.

  3. Mastering Social and Organization Goals: Strategy Use by Two Children with Asperger Syndrome during Cognitive Orientation to Daily Occupational Performance

    Science.gov (United States)

    Rodger, Sylvia; Vishram, Alysha

    2010-01-01

    Preliminary data supports the effectiveness of Cognitive Orientation to (daily) Occupational Performance (CO-OP) for children with Asperger syndrome (AS). Children with AS often experience social and organizational difficulties spanning daily occupations. This case study explored the pattern of Global Strategies and Domain-Specific Strategies…

  4. Anodal transcranial direct current stimulation of parietal cortex enhances action naming in Corticobasal Syndrome

    Directory of Open Access Journals (Sweden)

    Rosa eManenti

    2015-04-01

    Full Text Available Background: Corticobasal Syndrome (CBS is a neurodegenerative disorder that overlaps both clinically and neuropathologically with Frontotemporal dementia and is characterized by apraxia, alien limb phenomena, cortical sensory loss, cognitive impairment, behavioural changes and aphasia. It has been recently demonstrated that transcranial direct current stimulation (tDCS improves naming in healthy subjects and in subjects with language deficits.Objective: The aim of the present study was to explore the extent to which anodal transcranial direct current stimulation (anodal tDCS over the parietal cortex (PARC could facilitate naming performance in CBS subjects. Methods: Anodal tDCS was applied to the left and right PARC during object and action naming in seventeen patients with a diagnosis of possible CBS. Participants underwent two sessions of anodal tDCS (left and right and one session of placebo tDCS. Vocal responses were recorded and analyzed for accuracy and vocal Reaction Times (vRTs. Results: A shortening of naming latency for actions was observed only after active anodal stimulation over the left PARC, as compared to placebo and right stimulations. No effects have been reported for accuracy.Conclusions: Our preliminary finding demonstrated that tDCS decreased vocal reaction time during action naming in a sample of patients with CBS. A possible explanation of our results is that anodal tDCS over the left PARC effects the brain network implicated in action observation and representation. Further studies, based on larger patient samples, should be conducted to investigate the usefulness of tDCS as an additional treatment of linguistic deficits in CBS patients.

  5. Vascular manifestations of syndromic aortopathies: role of current and emerging imaging techniques

    International Nuclear Information System (INIS)

    Westerland, O.; Frigiola, A.; Robert, L.; Shaw, A.; Blakeway, L.; Katsanos, K.; Kiesewetter, C.; Chung, N.; Karunanithy, N.

    2015-01-01

    Patients with connective tissue diseases such as Marfan's syndrome, Loeys–Dietz syndrome, and vascular Ehlers–Danlos syndrome comprise a small but important group of patients who present early with acute aortic syndrome comprising aneurysmal dilation, rupture, or aortic dissection. Cardiovascular pathologies are an important yet treatable cause of morbidity and mortality in these patients. Imaging plays an important role in initial diagnosis, surveillance, and identification of complications. Furthermore, these patients are prone to developing complications in other vascular territories. Effective screening and surveillance will allow early diagnosis and elective treatment thus reducing the morbidity and mortality associated with presentation with acute complications. In this article, we will provide an overview of the role of magnetic resonance and computed tomography angiography in the management of syndromic aortopathies.

  6. Current demand of paediatric otolaryngology input for children with Down's syndrome in a tertiary referral centre.

    Science.gov (United States)

    Khalid-Raja, M; Tzifa, K

    2016-11-01

    This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery. ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

  7. Regeneration of the anterior cruciate ligament: Current strategies in tissue engineering

    Science.gov (United States)

    Nau, Thomas; Teuschl, Andreas

    2015-01-01

    Recent advancements in the field of musculoskeletal tissue engineering have raised an increasing interest in the regeneration of the anterior cruciate ligament (ACL). It is the aim of this article to review the current research efforts and highlight promising tissue engineering strategies. The four main components of tissue engineering also apply in several ACL regeneration research efforts. Scaffolds from biological materials, biodegradable polymers and composite materials are used. The main cell sources are mesenchymal stem cells and ACL fibroblasts. In addition, growth factors and mechanical stimuli are applied. So far, the regenerated ACL constructs have been tested in a few animal studies and the results are encouraging. The different strategies, from in vitro ACL regeneration in bioreactor systems to bio-enhanced repair and regeneration, are under constant development. We expect considerable progress in the near future that will result in a realistic option for ACL surgery soon. PMID:25621217

  8. Current Advancements and Strategies in Tissue Engineering for Wound Healing: A Comprehensive Review.

    Science.gov (United States)

    Ho, Jasmine; Walsh, Claire; Yue, Dominic; Dardik, Alan; Cheema, Umber

    2017-06-01

    Significance: With an aging population leading to an increase in diabetes and associated cutaneous wounds, there is a pressing clinical need to improve wound-healing therapies. Recent Advances: Tissue engineering approaches for wound healing and skin regeneration have been developed over the past few decades. A review of current literature has identified common themes and strategies that are proving successful within the field: The delivery of cells, mainly mesenchymal stem cells, within scaffolds of the native matrix is one such strategy. We overview these approaches and give insights into mechanisms that aid wound healing in different clinical scenarios. Critical Issues: We discuss the importance of the biomimetic niche, and how recapitulating elements of the native microenvironment of cells can help direct cell behavior and fate. Future Directions: It is crucial that during the continued development of tissue engineering in wound repair, there is close collaboration between tissue engineers and clinicians to maintain the translational efficacy of this approach.

  9. Rehabilitation strategies for partially edentulous-prosthodontic principles and current trends.

    Science.gov (United States)

    D'Souza, Dsj; Dua, Parag

    2011-07-01

    The prosthetic considerations for treatment of partially edentulous patients involve evaluation of important aspects such as presence of certain functional or skeletal deficits, orientation of the occlusal plane, free-way space, size and location of edentulous areas, number, strategic location and quality of the likely abutment teeth, vertical dimension, and the type of occlusion. A comprehensive evaluation, multidisciplinary approach and a sequential treatment plan, worked out in harmony with the patient's perceptions are important factors to ensure a successful outcome. This article discusses the principles, current trends and importance of clinical decisions in designing a treatment strategy when confronted with complex situations of partial edentulism.

  10. Current Therapeutic Strategies for Adipose Tissue Defects/Repair Using Engineered Biomaterials and Biomolecule Formulations

    Directory of Open Access Journals (Sweden)

    Christopher M. Mahoney

    2018-05-01

    Full Text Available Tissue engineered scaffolds for adipose restoration/repair has significantly evolved in recent years. Patients requiring soft tissue reconstruction, caused by defects or pathology, require biomaterials that will restore void volume with new functional tissue. The gold standard of autologous fat grafting (AFG is not a reliable option. This review focuses on the latest therapeutic strategies for the treatment of adipose tissue defects using biomolecule formulations and delivery, and specifically engineered biomaterials. Additionally, the clinical need for reliable off-the-shelf therapies, animal models, and challenges facing current technologies are discussed.

  11. Current Therapeutic Strategies for Adipose Tissue Defects/Repair Using Engineered Biomaterials and Biomolecule Formulations.

    Science.gov (United States)

    Mahoney, Christopher M; Imbarlina, Cayla; Yates, Cecelia C; Marra, Kacey G

    2018-01-01

    Tissue engineered scaffolds for adipose restoration/repair has significantly evolved in recent years. Patients requiring soft tissue reconstruction, caused by defects or pathology, require biomaterials that will restore void volume with new functional tissue. The gold standard of autologous fat grafting (AFG) is not a reliable option. This review focuses on the latest therapeutic strategies for the treatment of adipose tissue defects using biomolecule formulations and delivery, and specifically engineered biomaterials. Additionally, the clinical need for reliable off-the-shelf therapies, animal models, and challenges facing current technologies are discussed.

  12. Current technics and management strategy for Pu-contaminated wastes at PNC

    International Nuclear Information System (INIS)

    1981-02-01

    Power Reactor and Nuclear Fuel Development Corporation (PNC) was designated as a leading organization for the Pu-contaminated waste technology program in Japan. For this purpose, number of efforts in the research and development are proceeding. That is, Pu-contaminated waste technology including volume reduction system and the immobilization of wastes is being developed. The design of a Pu-contaminated waste treatment facility (PWTF) is being made for the demonstration of the technology developed. Studies are in progress to find the criteria for waste products in disposal. The current procedures and strategy for the management of Pu-contaminated wastes at PNC are described as follows: current and future management; technology development including controlled air incineration, acid digestion, immobilization melting, dismantling, and liquid waste treatment; the Pu-contaminated waste treatment facility. (J.P.N.)

  13. Impedance Based Analysis of DFIG Stator Current Unbalance and Distortion Suppression Strategies

    DEFF Research Database (Denmark)

    Song, Yipeng; Zhou, Dao; Blaabjerg, Frede

    2016-01-01

    The control strategies of Doubly Fed Induction Generator (DFIG) system output current unbalance and distortion suppression have been well investigated in detail, with the implementation of two kinds of resonant regulators, i.e., conventional Resonance (R) regulator or Vector Proportional Integral...... reshaping though the introduction of R and VPI regulator. It is pointed out that, when implemented in the DFIG system output current unbalance and distortion suppression, the VPI regulator (equivalent to the combination of virtual positive inductor and virtual positive resistor) has two advantages over R...... regulator (equivalent to the combination of virtual positive resistor and virtual negative inductor), i.e., better high order harmonic distortion suppression. The theoretical analysis and MATLAB simulation results have validated the correctness of this conclusion....

  14. A Current Review of the Diagnostic and Treatment Strategies of Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Z. Poh

    2012-01-01

    Full Text Available Hepatic encephalopathy (HE is a serious and potentially fatal complication in patients with cirrhotic liver disease. It is a spectrum ranging from minimal hepatic encephalopathy (MHE without recognizable clinical symptoms or signs, to overt HE with risk of cerebral edema and death. HE results in diminished quality of life and survival. The broad range of neuropsychiatric manifestations reflects the range of pathophysiological mechanisms and impairment in neurotransmission that are purported to cause HE including hyperammonemia, astrocyte swelling, intra-astrocytic glutamine, upregulation of 18-kDa translocator protein (TSPO (formerly known as peripheral benzodiazepine receptor or PBTR, and manganese. There is a myriad of diagnostic tools including simple bedside clinical assessment, and more complex neuropsychological batteries and neurophysiological tests available today. Current treatment strategies are directed at reducing ammonia, with newer agents showing some early promise. This paper describes the pathophysiology of the disease and summarises current diagnostic and treatment therapies available.

  15. Ciliates learn to diagnose and correct classical error syndromes in mating strategies.

    Science.gov (United States)

    Clark, Kevin B

    2013-01-01

    Preconjugal ciliates learn classical repetition error-correction codes to safeguard mating messages and replies from corruption by "rivals" and local ambient noise. Because individual cells behave as memory channels with Szilárd engine attributes, these coding schemes also might be used to limit, diagnose, and correct mating-signal errors due to noisy intracellular information processing. The present study, therefore, assessed whether heterotrich ciliates effect fault-tolerant signal planning and execution by modifying engine performance, and consequently entropy content of codes, during mock cell-cell communication. Socially meaningful serial vibrations emitted from an ambiguous artificial source initiated ciliate behavioral signaling performances known to advertise mating fitness with varying courtship strategies. Microbes, employing calcium-dependent Hebbian-like decision making, learned to diagnose then correct error syndromes by recursively matching Boltzmann entropies between signal planning and execution stages via "power" or "refrigeration" cycles. All eight serial contraction and reversal strategies incurred errors in entropy magnitude by the execution stage of processing. Absolute errors, however, subtended expected threshold values for single bit-flip errors in three-bit replies, indicating coding schemes protected information content throughout signal production. Ciliate preparedness for vibrations selectively and significantly affected the magnitude and valence of Szilárd engine performance during modal and non-modal strategy corrective cycles. But entropy fidelity for all replies mainly improved across learning trials as refinements in engine efficiency. Fidelity neared maximum levels for only modal signals coded in resilient three-bit repetition error-correction sequences. Together, these findings demonstrate microbes can elevate survival/reproductive success by learning to implement classical fault-tolerant information processing in social

  16. Life stressors, coping strategies, and social supports in patients with irritable bowel syndrome.

    Science.gov (United States)

    Roohafza, Hamidreza; Keshteli, Ammar Hassanzadeh; Daghaghzadeh, Hamed; Afshar, Hamid; Erfani, Zahra; Adibi, Peyman

    2016-01-01

    The frequency and the perceived intensity of life stressors, coping strategies, and social supports are very important in everybody's well-being. This study intended to estimate the relation of irritable bowel syndrome (IBS) and these factors. This was a cross-sectional study carried out in Isfahan on 2013. Data were extracted from the framework of the study on the epidemiology of psychological, alimentary health, and nutrition. Symptoms of IBS were evaluated by Talley bowel disease questionnaire. Stressful life event, modified COPE scale, and Multidimensional Scale of Perceived Social Support were also used. About 4763 subjects were completed questionnaires. Analyzing data were done by t -test and multivariate logistic regression. Of all returned questionnaire, 1024 (21.5%) were diagnosed with IBS. IBS and clinically-significant IBS (IBS-S) groups have significantly experienced a higher level of perceived intensity of stressors and had a higher frequency of stressors. The mean score of social supports and the mean scores of three coping strategies (problem engagement, support seeking, and positive reinterpretation and growth) were significantly lower in subjects with either IBS-S or IBS than in those with no IBS. Multivariate logistic regression revealed a significant association between frequency of stressors and perceived intensity of stressors with IBS (odds ratio [OR] =1.09 and OR = 1.02, respectively) or IBS-S (OR = 1.09 and OR = 1.03, respectively). People with IBS had higher numbers of stressors, higher perception of the intensity of stressors, less adaptive coping strategies, and less social supports which should be focused in psychosocial interventions.

  17. Ciliates learn to diagnose and correct classical error syndromes in mating strategies

    Directory of Open Access Journals (Sweden)

    Kevin Bradley Clark

    2013-08-01

    Full Text Available Preconjugal ciliates learn classical repetition error-correction codes to safeguard mating messages and replies from corruption by rivals and local ambient noise. Because individual cells behave as memory channels with Szilárd engine attributes, these coding schemes also might be used to limit, diagnose, and correct mating-signal errors due to noisy intracellular information processing. The present study, therefore, assessed whether heterotrich ciliates effect fault-tolerant signal planning and execution by modifying engine performance, and consequently entropy content of codes, during mock cell-cell communication. Socially meaningful serial vibrations emitted from an ambiguous artificial source initiated ciliate behavioral signaling performances known to advertise mating fitness with varying courtship strategies. Microbes, employing calcium-dependent Hebbian-like decision making, learned to diagnose then correct error syndromes by recursively matching Boltzmann entropies between signal planning and execution stages via power or refrigeration cycles. All eight serial contraction and reversal strategies incurred errors in entropy magnitude by the execution stage of processing. Absolute errors, however, subtended expected threshold values for single bit-flip errors in three-bit replies, indicating coding schemes protected information content throughout signal production. Ciliate preparedness for vibrations selectively and significantly affected the magnitude and valence of Szilárd engine performance during modal and nonmodal strategy corrective cycles. But entropy fidelity for all replies mainly improved across learning trials as refinements in engine efficiency. Fidelity neared maximum levels for only modal signals coded in resilient three-bit repetition error-correction sequences. Together, these findings demonstrate microbes can elevate survival/reproductive success by learning to implement classical fault-tolerant information processing in

  18. Current Screening Procedures for the Usher Syndrome at Residential Schools for the Deaf.

    Science.gov (United States)

    Day, Creagh Walker

    1982-01-01

    The results indicated that 53 percent of the schools that responded are screening students for Usher syndrome. One-half of the schools with screening programs offered some support services: personal counseling, genetic counseling, curricular modifications, and vocational counseling. (Author)

  19. Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy

    Directory of Open Access Journals (Sweden)

    Silvia Maria Lattanzio

    2018-04-01

    Full Text Available A 34-year-old woman suffered from significant chronic pain, depression, non-restorative sleep, chronic fatigue, severe morning stiffness, leg cramps, irritable bowel syndrome, hypersensitivity to cold, concentration difficulties, and forgetfulness. Blood tests were negative for rheumatic disorders. The patient was diagnosed with Fibromyalgia syndrome (FMS. Due to the lack of effectiveness of pharmacological therapies in FMS, she approached a novel metabolic proposal for the symptomatic remission. Its core idea is supporting serotonin synthesis by allowing a proper absorption of tryptophan assumed with food, while avoiding, or at least minimizing the presence of interfering non-absorbed molecules, such as fructose and sorbitol. Such a strategy resulted in a rapid improvement of symptoms after only few days on diet, up to the remission of most symptoms in 2 months. Depression, widespread chronic pain, chronic fatigue, non-restorative sleep, morning stiffness, and the majority of the comorbidities remitted. Energy and vitality were recovered by the patient as prior to the onset of the disease, reverting the occupational and social disabilities. The patient episodically challenged herself breaking the dietary protocol leading to its negative test and to the evaluation of its benefit. These breaks correlated with the recurrence of the symptoms, supporting the correctness of the biochemical hypothesis underlying the diet design toward remission of symptoms, but not as a final cure. We propose this as a low risk and accessible therapeutic protocol for the symptomatic remission in FMS with virtually no costs other than those related to vitamin and mineral salt supplements in case of deficiencies. A pilot study is required to further ground this metabolic approach, and to finally evaluate its inclusion in the guidelines for clinical management of FMS.

  20. Imaging biomarkers in Parkinson?s disease and Parkinsonian syndromes: current and emerging concepts

    OpenAIRE

    Saeed, Usman; Compagnone, Jordana; Aviv, Richard I.; Strafella, Antonio P.; Black, Sandra E.; Lang, Anthony E.; Masellis, Mario

    2017-01-01

    Two centuries ago in 1817, James Parkinson provided the first medical description of Parkinson?s disease, later refined by Jean-Martin Charcot in the mid-to-late 19th century to include the atypical parkinsonian variants (also termed, Parkinson-plus syndromes). Today, Parkinson?s disease represents the second most common neurodegenerative disorder with an estimated global prevalence of over 10 million. Conversely, atypical parkinsonian syndromes encompass a group of relatively heterogeneous d...

  1. Soil environmental quality in greenhouse vegetable production systems in eastern China: Current status and management strategies.

    Science.gov (United States)

    Hu, Wenyou; Zhang, Yanxia; Huang, Biao; Teng, Ying

    2017-03-01

    Greenhouse vegetable production (GVP) has become an important source of public vegetable consumption and farmers' income in China. However, various pollutants can be accumulated in GVP soils due to the high cropping index, large agricultural input, and closed environment. Ecological toxicity caused by excessive pollutants' accumulation can then lead to serious health risks. This paper was aimed to systematically review the current status of soil environmental quality, analyze their impact factors, and consequently to propose integrated management strategies for GVP systems. Results indicated a decrease in soil pH, soil salinization, and nutrients imbalance in GVP soils. Fungicides, remaining nutrients, antibiotics, heavy metals, and phthalate esters were main pollutants accumulating in GVP soils comparing to surrounding open field soils. Degradation of soil ecological function, accumulation of major pollutants in vegetables, deterioration of neighboring water bodies, and potential human health risks has occurred due to the changes of soil properties and accumulation of pollutants such as heavy metals and fungicides in soils. Four dominant factors were identified leading to the above-mentioned issues including heavy application of agricultural inputs, outmoded planting styles with poor environmental protection awareness, old-fashion regulations, unreasonable standards, and ineffective supervisory management. To guarantee a sustainable GVP development, several strategies were suggested to protect and improve soil environmental quality. Implementation of various strategies not only requires the concerted efforts among different stakeholders, but also the whole lifecycle assessment throughout the GVP processes as well as effective enforcement of policies, laws, and regulations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Current strategies for the restoration of adequate lordosis during lumbar fusion

    Science.gov (United States)

    Barrey, Cédric; Darnis, Alice

    2015-01-01

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery. PMID:25621216

  3. Regenerating the human heart: direct reprogramming strategies and their current limitations.

    Science.gov (United States)

    Ghiroldi, Andrea; Piccoli, Marco; Ciconte, Giuseppe; Pappone, Carlo; Anastasia, Luigi

    2017-10-27

    Cardiovascular diseases are the leading cause of death in the Western world. Unfortunately, current therapies are often only palliative, consequently essentially making heart transplantation necessary for many patients. However, several novel therapeutic approaches in the past two decades have yielded quite encouraging results. The generation of induced pluripotent stem cells, through the forced expression of stem cell-specific transcription factors, has inspired the most promising strategies for heart regeneration by direct reprogramming of cardiac fibroblasts into functional cardiomyocytes. Initial attempts at this reprogramming were conducted using a similar approach to the one used with transcription factors, but during years, novel strategies have been tested, e.g., miRNAs, recombinant proteins and chemical molecules. Although preliminary results on animal models are promising, the low reprogramming efficiency, as well as the incomplete maturation of the cardiomyocytes, still represents important obstacles. This review covers direct transdifferentiation strategies that have been proposed and developed and illustrates the pros and cons of each approach. Indeed, as described in the manuscript, there are still many unanswered questions and drawbacks that require a better understanding of the basic signaling pathways and transcription factor networks before functional cells, suitable for cardiac regeneration and safe for the patients, can be generated and used for human therapies.

  4. A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome.

    Science.gov (United States)

    Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

    2014-09-01

    Lynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes. To evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged strategies for individuals in whom LS is identified. Systematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed. Inconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing. The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI and BRAF testing [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the

  5. Parameter Improved Particle Swarm Optimization Based Direct-Current Vector Control Strategy for Solar PV System

    Directory of Open Access Journals (Sweden)

    NAMMALVAR, P.

    2018-02-01

    Full Text Available This paper projects Parameter Improved Particle Swarm Optimization (PIPSO based direct current vector control technology for the integration of photovoltaic array in an AC micro-grid to enhance the system performance and stability. A photovoltaic system incorporated with AC micro-grid is taken as the pursuit of research study. The test system features two power converters namely, PV side converter which consists of DC-DC boost converter with Perturbation and Observe (P&O MPPT control to reap most extreme power from the PV array, and grid side converter which consists of Grid Side-Voltage Source Converter (GS-VSC with proposed direct current vector control strategy. The gain of the proposed controller is chosen from a set of three values obtained using apriori test and tuned through the PIPSO algorithm so that the Integral of Time multiplied Absolute Error (ITAE between the actual and the desired DC link capacitor voltage reaches a minimum and allows the system to extract maximum power from PV system, whereas the existing d-q control strategy is found to perform slowly to control the DC link voltage under varying solar insolation and load fluctuations. From simulation results, it is evident that the proposed optimal control technique provides robust control and improved efficiency.

  6. HIV cure strategies: how good must they be to improve on current antiretroviral therapy?

    Directory of Open Access Journals (Sweden)

    Paul E Sax

    Full Text Available We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART.We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT, each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving.Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.

  7. Prevention and Control Strategies to Counter Zika Virus, a Special Focus on Intervention Approaches against Vector Mosquitoes—Current Updates

    Directory of Open Access Journals (Sweden)

    Raj K. Singh

    2018-02-01

    Full Text Available Zika virus (ZIKV is the most recent intruder that acquired the status of global threat creating panic and frightening situation to public owing to its rapid spread, attaining higher virulence and causing complex clinical manifestations including microcephaly in newborns and Guillain Barré Syndrome. Alike other flaviviruses, the principal mode of ZIKV transmission is by mosquitoes. Advances in research have provided reliable diagnostics for detecting ZIKV infection, while several drug/therapeutic targets and vaccine candidates have been identified recently. Despite these progresses, currently there is neither any effective drug nor any vaccine available against ZIKV. Under such circumstances and to tackle the problem at large, control measures of which mosquito population control need to be strengthened following appropriate mechanical, chemical, biological and genetic control measures. Apart from this, several other known modes of ZIKV transmission which have gained importance in recent past such as intrauterine, sexual intercourse, and blood-borne spread need to be checked and kept under control by adopting appropriate precautions and utmost care during sexual intercourse, blood transfusion and organ transplantation. The virus inactivation by pasteurization, detergents, chemicals, and filtration can effectively reduce viral load in plasma-derived medicinal products. Added to this, strengthening of the surveillance and monitoring of ZIKV as well as avoiding travel to Zika infected areas would aid in keeping viral infection under check. Here, we discuss the salient advances in the prevention and control strategies to combat ZIKV with a focus on highlighting various intervention approaches against the vector mosquitoes of this viral pathogen along with presenting an overview regarding human intervention measures to counter other modes of ZIKV transmission and spread. Additionally, owing to the success of vaccines for a number of infections

  8. Retrieving current and wind vectors from ATI SAR data: airborne evidence and inversion strategy

    Science.gov (United States)

    Martin, Adrien; Gommenginger, Christine; Chapron, Bertrand; Marquez, José; Doody, Sam

    2017-04-01

    Conventional and along-track interferometric (ATI) Synthetic Aperture Radar (SAR) sense the motion of the ocean surface by measuring the Doppler shift of reflected signals. Together with the water displacement associated with ocean currents, the SAR measurements are also affected by a Wind-wave induced Artefact Surface Velocity (WASV) caused by the velocity of Bragg scatterers and the orbital velocity of ocean surface gravity waves. The WASV has been modelled theoretically in past studies but has been estimated empirically only once using Envisat ASAR. Here we propose, firstly, to evaluate this WASV from airborne ATI SAR data, secondly, to validate the airborne retrieved surface current after correction of the WASV against HF radar measurements and thirdly to examine the best inversion strategy for a an Ocean Surface Current (OSC) satellite mission to retrieve accurately both the ocean surface current vector (OSCV) and the wind vector in the frame of an OSC satellite mission. The airborne ATI SAR data were acquired in the tidally dominated Irish Sea using a Wavemill-type dual-beam SAR interferometer. A comprehensive collection of airborne Wavemill data acquired in a star pattern over a well-instrumented site made it possible to estimate the magnitude and dependence on azimuth and incidence angle of the WASV. The airborne results compare favourably with those reported for Envisat ASAR, empirical model, which has been used to correct for it. Validation of the current retrieval capabilities of the proof-of-concept has been conducted against HF radar giving a precisions typically better than 0.1 m/s for surface current speed and 7° for direction. Comparisons with POLCOMS (1.8 km) indicate that the model reproduces well the overall temporal evolution but does not capture the high spatial variability of ocean surface currents at the maximum ebb flow. Airborne retrieved currents highlight a short-scale spatial variability up to 100m related to bathymetry channels, which

  9. Brain tumor radiosurgery. Current status and strategies to enhance the effect of radiosurgery

    International Nuclear Information System (INIS)

    Niranjan, A.; Lunsford, L.D.; Gobbel, G.T.; Kondziolka, D.; Maitz, A.; Flickinger, J.C.

    2000-01-01

    First, the current status of brain tumor radiosurgery is reviewed, and radiosurgery for brain tumors, including benign tumors, malignant tumors, primary glial tumors, and metastatic tumors, is described. Rapid developments in neuroimaging, stereotactic techniques, and robotic technology in the last decade have contributed to improved results and wider applications of radiosurgery. Radiosurgery has become the preferred management modality for many intracranial tumors, including schwannomas, meningiomas, and metastatic tumors. Although radiosurgery provides survival benefits in patients with diffuse malignant brain tumors, cure is still not possible. Microscopic tumor infiltration into surrounding normal tissue is the main cause of recurrence. Additional strategies are needed to specifically target tumor cells. Next, strategies to enhance the effect of radiosurgery are reviewed. Whereas the long-term clinical results of radiosurgery have established its role in the treatment of benign tumors, additional strategies are needed to improve cell killing in malignant brain tumors and to protect normal surrounding brain. The first strategy included the use of various agents to protect normal brain while delivering a high dose to the tumor cells, but finding an effective radioprotective agent has been problematic. Pentobarbital and 21-aminosteroid (21-AS) are presented as examples. The second strategy for radiation protection aimed at the repair of radiation-induced damage to the normal brain. The cause of radiation-induced breakdown of normal tissue is unclear. The white matter and the cerebral vasculature appear to be particularly susceptible to radiation. Oligodendrocytes and endothelial cells may be critical targets of radiation. The authors hypothesize that radiation-induced damage to these cell types can be repaired by neural stem cells. They also describe the use of tumor necrosis factor alpha (TNF-alpha) and neural stem cells as a means of enhancing the effect of

  10. Traditional Chinese Medicine for Refractory Nephrotic Syndrome: Strategies and Promising Treatments

    Science.gov (United States)

    Tu, Yuan-Chao

    2018-01-01

    Refractory nephrotic syndrome (RNS) is an immune-related kidney disease with poor clinical outcomes. Standard treatments include corticosteroids as the initial therapy and other immunosuppressants as second-line options. A substantial proportion of patients with RNS are resistant to or dependent on immunosuppressive drugs and often experience unremitting edema and proteinuria, cycles of remission and relapse, and/or serious adverse events due to long-term immunosuppression. Traditional Chinese medicine has a long history of treating complicated kidney diseases and holds great potential for providing effective treatments for RNS. This review describes the Chinese medical theories relating to the pathogenesis of RNS and discusses the strategies and treatment options using Chinese herbal medicine. Available preclinical and clinical evidence strongly supports the integration of traditional Chinese medicine and Western medicine for improving the outcome of RNS. Herbal medicine such as Astragalus membranaceus, Stephania tetrandra S. Moore, and Tripterygium wilfordii Hook F can serve as the alternative therapy when patients fail to respond to immunosuppression or as the complementary therapy to improve therapeutic efficacy and reduce side effects of immunosuppressive agents. Wuzhi capsules (Schisandra sphenanthera extract) with tacrolimus and tetrandrine with corticosteroids are two herb-drug combinations that have shown great promise and warrant further studies. PMID:29507594

  11. Linkage studies on Gilles de la Tourette syndrome: What is the strategy of choice?

    Energy Technology Data Exchange (ETDEWEB)

    Heutink, P.; Wetering, J.M. van de; Oostra, B.A. [Erasmus Univ. Rotterdam (Netherlands)] [and others

    1995-08-01

    For a linkage study it is important to ascertain family material that is sufficiently informative. The statistical power of linkage sample can be determined via computer simulation. For complex traits uncertain parameters such as incomplete penetrance, frequency of phenocopies, gene frequency and variable expression have to be taken into account. One can either include only the most severe phenotype in the analysis or apply multiple linkage tests for a gradually broadened disease phenotype. Gilles de la Tourette syndrome (GTS) is a chronic neurological disorder characterized by multiple, intermittent motor and vocal tics. Segregation analyses suggests that GTS and milder phenotypes are caused by a single dominant gene. We report here the results of an extensive simulation study on a large set of families. We compared the effectiveness of linkage tests with only the GTS phenotype versus multiple tests that included various milder phenotypes and different gene frequencies. The scenario of multiple tests yielded superior power. Our results show that computer simulation can indicate the strategy of choice in linkage studies of multiple, complex phenotypes. 33 refs., 2 figs., 3 tabs.

  12. Training in Compensatory Strategies Enhances Rapport in Interactions Involving People with Möbius Syndrome

    Directory of Open Access Journals (Sweden)

    John eMichael

    2015-10-01

    Full Text Available In the exploratory study reported here, we tested the efficacy of an intervention designed to train teenagers with Möbius Syndrome (MS to increase the use of alternative communication strategies (e.g. gestures to compensate for their lack of facial expressiveness. Specifically, we expected the intervention to increase the level of rapport experienced in social interactions by our participants. In addition, we aimed to identify the mechanisms responsible for any such increase in rapport. In the study, five teenagers with MS interacted with three naïve participants without MS before the intervention, and with three different naïve participants without MS after the intervention. Rapport was assessed by self-report and by behavioral coders who rated videos of the interactions. Individual nonverbal behavior was assessed via behavioral coders, while verbal behavior was automatically extracted from the sound files. Alignment was assessed using cross recurrence quantification analysis and mixed effects models. The results showed that observer-coded rapport was greater after the intervention, whereas self-reported rapport did not change significantly. Observer-coded gesture and expressivity increased in participants with and without MS, while overall linguistic alignment decreased. Fidgeting and repetitiveness of verbal behavior also decreased in both groups. In sum, the intervention may impact nonverbal and verbal behavior in participants with and without MS, increasing rapport as well as overall gesturing, while decreasing alignment.

  13. A novel strategy for hemolytic uremic syndrome: successful treatment with thrombomodulin α.

    Science.gov (United States)

    Honda, Takashi; Ogata, Shohei; Mineo, Eri; Nagamori, Yukako; Nakamura, Shinya; Bando, Yuki; Ishii, Masahiro

    2013-03-01

    Hemolytic uremic syndrome (HUS) is a life-threatening infectious disease in childhood for which there is no confirmed therapeutic strategy. Endothelial inflammation leading to microthrombosis formation via complement activation is the main pathology of HUS. Thrombomodulin is an endothelial membrane protein that has anticoagulation and anti-inflammatory effects, including the suppression of complement activity. Recombinant human soluble thrombomodulin (rTM) is a novel therapeutic medicine for disseminated intravascular coagulation. We administered rTM to 3 patients with HUS for 7 days and investigated the outcomes in view of the patients' prognoses, changes in biochemical markers, complications, and adverse effects of rTM. Symptoms and laboratory data improved after initiation of rTM in all 3 patients. Abnormal activation of complements was also dramatically suppressed in 1 patient. The patients recovered without any complications or adverse effects of rTM. They were discharged having normal neurologic status and with no renal dysfunction. To our knowledge, this is the first report of rTM being used to treat HUS. These case reports show the positive effect of rTM in patients with HUS. Randomized controlled studies should be performed to assess the efficacy and safety of rTM for children with HUS.

  14. Extended Occupational Therapy Reintegration Strategies for a Woman With Guillain-Barré Syndrome: Case Report.

    Science.gov (United States)

    Tomita, Machiko R; Buckner, Kathryn; Saharan, Sumandeep; Persons, Kimberley; Liao, Sheng Hui

    2016-01-01

    This case report describes a unique long-term functional recovery process to promote successful community reintegration for a woman with Guillain-Barré syndrome (GBS), a rare autoimmune disease. Her main symptoms were very limited mobility and depressive symptoms due to the unknown cause of and cure for the illness. Holistic occupational strategies helped the client stabilize her emotional state, create a safe home environment, improve a communication method, increase physical activity, and promote social participation. Participation in a fall prevention clinical trial lowered her risk of falling; at 9 mo, she reached 75% of the maximum Social Integration score; at 13 mo, she reached near-normal level for activities of daily living (ADLs) and her fastest time for the Timed Up and Go test; and at 2 yr, she achieved a 100% score in instrumental ADLs. For community integration of clients with GBS, a comprehensive strategic self-management approach should be prescribed for long-term recovery. Copyright © 2016 by the American Occupational Therapy Association, Inc.

  15. Therapeutic Strategies in Fragile X Syndrome: Dysregulated mGluR Signaling and Beyond

    Science.gov (United States)

    Gross, Christina; Berry-Kravis, Elizabeth M; Bassell, Gary J

    2012-01-01

    Fragile X syndrome (FXS) is an inherited neurodevelopmental disease caused by loss of function of the fragile X mental retardation protein (FMRP). In the absence of FMRP, signaling through group 1 metabotropic glutamate receptors is elevated and insensitive to stimulation, which may underlie many of the neurological and neuropsychiatric features of FXS. Treatment of FXS animal models with negative allosteric modulators of these receptors and preliminary clinical trials in human patients support the hypothesis that metabotropic glutamate receptor signaling is a valuable therapeutic target in FXS. However, recent research has also shown that FMRP may regulate diverse aspects of neuronal signaling downstream of several cell surface receptors, suggesting a possible new route to more direct disease-targeted therapies. Here, we summarize promising recent advances in basic research identifying and testing novel therapeutic strategies in FXS models, and evaluate their potential therapeutic benefits. We provide an overview of recent and ongoing clinical trials motivated by some of these findings, and discuss the challenges for both basic science and clinical applications in the continued development of effective disease mechanism-targeted therapies for FXS. PMID:21796106

  16. Periodically Swapping Modulation (PSM) Strategy for Three-Level (TL) DC/DC Converter with Balanced Switch Currents

    DEFF Research Database (Denmark)

    Liu, Dong; Deng, Fujin; Zhang, Qi

    2018-01-01

    The asymmetrical modulation strategy is widely used in various types of three-level (TL) DC/DC converters, while the current imbalance among the power switches is one of the important issues. In this paper, a novel periodically swapping modulation (PSM) strategy is proposed for balancing the power...... switches’ currents in various types of TL DC/DC converters. In the proposed PSM strategy, the driving signals of the switch pairs are swapped periodically, which guarantees that the currents through the power switches are kept balanced in every two switching periods. Therefore, the proposed PSM...... strategy can effectively improve the reliability of the converter by balancing the power losses and thermal stresses among the power switches. The operation principle and performances of the proposed PSM strategy are analyzed in detail. Finally, the simulation and experimental results are presented...

  17. Strategies to enhance biologically active-secondary metabolites in cell cultures of Artemisia - current trends.

    Science.gov (United States)

    Ali, Mohammad; Abbasi, Bilal Haider; Ahmad, Nisar; Khan, Haji; Ali, Gul Shad

    2017-11-01

    The genus Artemisia has been utilized worldwide due to its immense potential for protection against various diseases, especially malaria. Artemisia absinthium, previously renowned for its utilization in the popular beverage absinthe, is gaining resurgence due to its extensive pharmacological activities. Like A. annua, this species exhibits strong biological activities like antimalarial, anticancer and antioxidant. Although artemisinin was found to be the major metabolite for its antimalarial effects, several flavonoids and terpenoids are considered to possess biological activities when used alone and also to synergistically boost the bioavailability of artemisinin. However, due to the limited quantities of these metabolites in wild plants, in vitro cultures were established and strategies have been adopted to enhance medicinally important secondary metabolites in these cultures. This review elaborates on the traditional medicinal uses of Artemisia species and explains current trends to establish cell cultures of A. annua and A. absinthium for enhanced production of medicinally important secondary metabolites.

  18. Beam physics design strategy for a high-current rf linac

    Energy Technology Data Exchange (ETDEWEB)

    Reiser, M. [Univ. of Maryland, College Park, MD (United States)

    1995-10-01

    The high average beam power of an rf linac system for transmutation of nuclear waste puts very stringent requirements on beam quality and beam control. Fractional beam losses along the accelerator must be kept at extremely low levels to assure {open_quotes}hands-on{close_quotes} maintenance. Hence, halo formation and large-amplitude tails in the particle distribution due to beam mismatch and equipartitioning effects must be avoided. This implies that the beam should ideally be in near-perfect thermal equilibrium from injection to full energy - in contrast to existing rf linacs in which the transverse temperature, T {sub {perpendicular}}, is higher than the longitudinal temperature, T{sub {parallel}}. The physics and parameter scaling for such a system will be reviewed using the results of recent work on high-intensity bunched beams. A design strategy for a high-current rf linac with equilibrated beam will be proposed.

  19. Classical Ecological Restoration and its Current Challenges: Assisted Migration as an Adaptation Strategy to Climate Change

    Directory of Open Access Journals (Sweden)

    Pilar A. Gómez-Ruiz

    2017-06-01

    Full Text Available Ecological restoration is a very active area in ecology and of great importance for ecosystems management. Despite of being a relatively young discipline, the classical concepts of restoration seem, at present, impractical considering the great challenges generated by modification and destruction of ecosystems. This is due to anthropic activities (deforestation, change of land use, pollution and global climate change. In the classic definition of restoration, the objective is to recover the degraded ecosystem to the same conditions of a historical reference state. However, nowadays the ecosystems return to a state prior to the disturbances seems unviable, because the thresholds of resilience have already been overcome. Additionally, climate change is causing environmental changes at an unprecedented rate. For this reason, ecological restoration needs to unite efforts of diverse actors to recover ecosystems that can be sustainable and functional in the future, where the species could be able to tolerate the environmental conditions that will exist in the long term. Assisted migration has been proposed as a conservation strategy; it is defined as the translocation of species to new locations outside their known range of distribution. In the current context of loss of diversity and ecosystems, this strategy could be fundamental for the formation of new communities that can later become novel ecosystems where species that are fundamental to the dynamics of ecosystems can persist and, at the same time, recover function, structure and resilience.

  20. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies.

    Science.gov (United States)

    König, M A; Jehan, S; Boszczyk, A A; Boszczyk, B M

    2012-05-01

    U-shaped sacral fractures usually result from axial loading of the spine with simultaneous sacral pivoting due to a horizontal fracture which leads to a highly unstable spino-pelvic dissociation. Due to the rarity of these fractures, there is lack of an agreed treatment strategy. A thorough literature search was carried out to identify current treatment concepts. The studies were analysed for mechanism of injury, diagnostic imaging, associated injuries, type of surgery, follow-up times, complications, neurological, clinical and radiological outcome. Sixty-three cases were found in 12 articles. No Class I, II or III evidence was found in the literature. The most common mechanism of injury was a fall or jump from height. Pre-operative neurological deficit was noted in 50 (94.3%) out of 53 cases (not available in 10 patients). The most used surgical options were spino-pelvic fixation with or without decompression and ilio-sacral screws. Post-operative complications occurred in 24 (38.1%) patients. Average follow-up time was 18.6 months (range 2-34 months). Full neurological recovery was noted in 20 cases, partial recovery in 14 and 9 patients had no neurological recovery (5 patients were lost in follow-up). Fracture healing was mentioned in 7 articles with only 1 case of fracture reduction loss. From the current available data, an evidence based treatment strategy regarding outcome, neurological recovery or fracture healing could not be identified. Limited access and minimal-invasive surgery focussing on sacral reduction and restoration seems to offer comparable results to large spino-pelvic constructs with fewer complications and should be considered as the method of choice. If the fracture is highly unstable and displaced, spino-pelvic fixation might offer better stability.

  1. The Efficacy of Rehearsal Strategy on Auditory Short-Term Memory of Educable 5 to 8 Years Old Children with Down Syndrome

    OpenAIRE

    Esmaeil Esmaieli; Ma'soumeh Pourmohammadreza-Tajrishi; Sahel Hemmati; Akbar Biglarian

    2014-01-01

    Objective: One of the problems of children with Down syndrome is their low performance on retention of information and its recall in the memory. The present study aimed to determine the efficacy of rehearsal strategy on auditory short-term memory of educable 5 to 8 years old children with Down syndrome. Materials & Methods: In this quasi-experimental study, 24 children (14 boys and 10 girls) were selected in convenience from Iranian Down Syndrome Charity Association and evaluated by Raven...

  2. COIN Goes GLOCAL: Traditional COIN With a Global Perspective: Does the Current US Strategy Reflect COIN Theory, Doctrine and Principles

    Science.gov (United States)

    2007-05-17

    COIN goes “ GLOCAL ”: Traditional COIN with a Global Perspective: Does the Current US Strategy Reflect COIN Theory, Doctrine and Principles? A...TITLE AND SUBTITLE COIN goes “ GLOCAL ”: Traditional COIN with a Global P ti D th C t US St t R fl t COIN 5a. CONTRACT NUMBER Perspective: Does...Monograph: COIN goes “ GLOCAL ”: Traditional COIN with a Global Perspective: Does the Current US Strategy Reflect COIN Theory, Doctrine and Principles

  3. Current discharge management of acute coronary syndromes: Data from the Rijnmond Collective Cardiology Research (CCR) study

    NARCIS (Netherlands)

    T. Yetgin; M.M.J.M. van der Linden (Mark); A.G. de Vries (A.); P.C. Smits (Pieter); R. van Mechelen; S-C. Yap (Sing-Chien); H. Boersma (Eric); F. Zijlstra (Felix); R.J.M. van Geuns (Robert Jan)

    2014-01-01

    textabstractBackground Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics

  4. Relationship between current level of immunodeficiency and non-acquired immunodeficiency syndrome-defining malignancies

    DEFF Research Database (Denmark)

    Reekie, Joanne; Kosa, Csaba; Engsig, Frederik

    2010-01-01

    In the combined antiretroviral therapy (cART) era, non-acquired immunodeficiency syndrome (AIDS)-defining malignancies account for more morbidity and mortality in human immunodeficiency virus-infected patients than AIDS-defining malignancies. However, conflicting data have been reported...

  5. White-nose syndrome in bats: an overview of current knowledge for land managers

    Science.gov (United States)

    Roger W. Perry

    2013-01-01

    White-nose syndrome recently emerged as a disease affecting bats that hibernate in caves and abandoned mines during winter. This disease is caused by the fungus Pseudogymnoascus destructans, and has caused the death of millions of bats in the Eastern United States and Canada. This fungus grows in relatively cold conditions with high humidity, which...

  6. Corneal Deformation Response and Ocular Geometry: A Non-invasive Diagnostic Strategy in Marfan Syndrome

    Science.gov (United States)

    Beene, Lauren C.; Traboulsi, Elias I.; Seven, Ibrahim; Ford, Matthew R.; Roy, Abhijit Sinha; Butler, Robert S.; Dupps, William J.

    2015-01-01

    Purpose To evaluate corneal air-puff deformation responses and ocular geometry as predictors of Marfan syndrome. Design Prospective observational clinical study Methods Sixteen investigator-derived, 4 standard Ocular Response Analyzer (ORA), and geometric variables from corneal tomography and optical biometry using Oculus Pentacam and IOL Master were assessed for discriminative value in Marfan syndrome, measuring right eyes of 24 control and 13 Marfan syndrome subjects. Area under the receiver operating characteristic (AUROC) curve was assessed in univariate and multivariate analyses Results Six investigator-derived ORA variables successfully discriminated Marfan syndrome. The best lone disease predictor was Concavity Min (Marfan syndrome 47.5 ± 20, control 69 ± 14, p = 0.003; AUROC = 0.80). Corneal hysteresis and corneal resistance factor were decreased (Marfan syndrome CH 9.45 ± 1.62, control CH 11.24 ± 1.21, p = 0.01; Marfan syndrome CRF 9.77 ± 1.65, control CRF 11.03 ± 1.72, p = 0.01) and corneas were flatter in Marfan syndrome (Marfan syndrome Kmean 41.25 ± 2.09 D, control Kmean 42.70 ± 1.81 D, p = 0.046). No significant differences were observed in central corneal thickness, axial eye length, or intraocular pressure. A multivariate regression model incorporating corneal curvature and hysteresis loop area (HLA) provided the best predictive value for Marfan syndrome (AUROC = 0.85). Conclusions This study describes novel biodynamic features of corneal deformation responses in Marfan syndrome, including increased deformation, decreased bending resistance, and decreased energy dissipation capacity. A predictive model incorporating HLA and corneal curvature shows greatest potential for non-invasive clinical diagnosis of Marfan syndrome. PMID:26432567

  7. Corneal Deformation Response and Ocular Geometry: A Noninvasive Diagnostic Strategy in Marfan Syndrome.

    Science.gov (United States)

    Beene, Lauren C; Traboulsi, Elias I; Seven, Ibrahim; Ford, Matthew R; Sinha Roy, Abhijit; Butler, Robert S; Dupps, William J

    2016-01-01

    To evaluate corneal air-puff deformation responses and ocular geometry as predictors of Marfan syndrome. Prospective observational clinical study. Sixteen investigator-derived, 4 standard Ocular Response Analyzer (ORA), and geometric variables from corneal tomography and optical biometry using Oculus Pentacam and IOL Master were assessed for discriminative value in Marfan syndrome, measuring right eyes of 24 control and 13 Marfan syndrome subjects. Area under the receiver operating characteristic (AUROC) curve was assessed in univariate and multivariate analyses. Six investigator-derived ORA variables successfully discriminated Marfan syndrome. The best lone disease predictor was Concavity Min (Marfan syndrome 47.5 ± 20, control 69 ± 14, P = .003; AUROC = 0.80). Corneal hysteresis (CH) and corneal resistance factor (CRF) were decreased (Marfan syndrome CH 9.45 ± 1.62, control CH 11.24 ± 1.21, P = .01; Marfan syndrome CRF 9.77 ± 1.65, control CRF 11.03 ± 1.72, P = .01) and corneas were flatter in Marfan syndrome (Marfan syndrome Kmean 41.25 ± 2.09 diopter, control Kmean 42.70 ± 1.81 diopter, P = .046). No significant differences were observed in central corneal thickness, axial eye length, or intraocular pressure. A multivariate regression model incorporating corneal curvature and hysteresis loop area (HLA) provided the best predictive value for Marfan syndrome (AUROC = 0.85). This study describes novel biodynamic features of corneal deformation responses in Marfan syndrome, including increased deformation, decreased bending resistance, and decreased energy dissipation capacity. A predictive model incorporating HLA and corneal curvature shows greatest potential for noninvasive clinical diagnosis of Marfan syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Current Strategies for the Manufacture of Small Size Tissue Engineering Vascular Grafts

    Directory of Open Access Journals (Sweden)

    Michele Carrabba

    2018-04-01

    Full Text Available Occlusive arterial disease, including coronary heart disease (CHD and peripheral arterial disease (PAD, is the main cause of death, with an annual mortality incidence predicted to rise to 23.3 million worldwide by 2030. Current revascularization techniques consist of angioplasty, placement of a stent, or surgical bypass grafting. Autologous vessels, such as the saphenous vein and internal thoracic artery, represent the gold standard grafts for small-diameter vessels. However, they require invasive harvesting and are often unavailable. Synthetic vascular grafts represent an alternative to autologous vessels. These grafts have shown satisfactory long-term results for replacement of large- and medium-diameter arteries, such as the carotid or common femoral artery, but have poor patency rates when applied to small-diameter vessels, such as coronary arteries and arteries below the knee. Considering the limitations of current vascular bypass conduits, a tissue-engineered vascular graft (TEVG with the ability to grow, remodel, and repair in vivo presents a potential solution for the future of vascular surgery. Here, we review the different methods that research groups have been investigating to create TEVGs in the last decades. We focus on the techniques employed in the manufacturing process of the grafts and categorize the approaches as scaffold-based (synthetic, natural, or hybrid or self-assembled (cell-sheet, microtissue aggregation and bioprinting. Moreover, we highlight the attempts made so far to translate this new strategy from the bench to the bedside.

  9. Improvement Strategies, Cost Effective Production, and Potential Applications of Fungal Glucose Oxidase (GOD): Current Updates.

    Science.gov (United States)

    Dubey, Manish K; Zehra, Andleeb; Aamir, Mohd; Meena, Mukesh; Ahirwal, Laxmi; Singh, Siddhartha; Shukla, Shruti; Upadhyay, Ram S; Bueno-Mari, Ruben; Bajpai, Vivek K

    2017-01-01

    Fungal glucose oxidase (GOD) is widely employed in the different sectors of food industries for use in baking products, dry egg powder, beverages, and gluconic acid production. GOD also has several other novel applications in chemical, pharmaceutical, textile, and other biotechnological industries. The electrochemical suitability of GOD catalyzed reactions has enabled its successful use in bioelectronic devices, particularly biofuel cells, and biosensors. Other crucial aspects of GOD such as improved feeding efficiency in response to GOD supplemental diet, roles in antimicrobial activities, and enhancing pathogen defense response, thereby providing induced resistance in plants have also been reported. Moreover, the medical science, another emerging branch where GOD was recently reported to induce several apoptosis characteristics as well as cellular senescence by downregulating Klotho gene expression. These widespread applications of GOD have led to increased demand for more extensive research to improve its production, characterization, and enhanced stability to enable long term usages. Currently, GOD is mainly produced and purified from Aspergillus niger and Penicillium species, but the yield is relatively low and the purification process is troublesome. It is practical to build an excellent GOD-producing strain. Therefore, the present review describes innovative methods of enhancing fungal GOD production by using genetic and non-genetic approaches in-depth along with purification techniques. The review also highlights current research progress in the cost effective production of GOD, including key advances, potential applications and limitations. Therefore, there is an extensive need to commercialize these processes by developing and optimizing novel strategies for cost effective GOD production.

  10. Current status and strategies for the control of viral hepatitis A in Korea.

    Science.gov (United States)

    Yoon, Eileen L; Sinn, Dong Hyun; Lee, Hyun Woong; Kim, Ji Hoon

    2017-09-01

    Hepatitis A virus is one of the most frequent causes of foodborne infection, which is closely associated with sanitary conditions and hygienic practices. The clinical spectrum of acute hepatitis A is wide, ranging from mild case without any noticeable symptoms to severe case with acute liver failure leading to mortality. The severity and outcome are highly correlated with age at infection. In developing countries, most people are infected in early childhood without significant symptom. Ironically, in area where sanitary condition has improved rapidly, adults who do not have immunity for viral hepatitis A (VH-A) in early childhood is accumulating. Adults without immunity are exposed to risks of symptomatic disease and large outbreaks in society. In Korea, where hygiene has improved rapidly, acute hepatitis A is a significant health burden that needs to be managed with nationwide health policy. The incidence of symptomatic VH-A has increased since 2000 and peaked in 2009. Korea has designated hepatitis A as a group 1 nationally notifiable infectious disease in 2001. Since 2001, mandatory surveillance system has been established to detect every single case of acute hepatitis A. Universal, nationwide vaccination program for newborns was introduced in 2015. In this review, we will present the current epidemiologic status of viral hepatitis A, and evaluate the effectiveness of the current nationwide strategies for the control of viral hepatitis A in Korea. Furthermore, we presented some action proposals that can help eliminate viral hepatitis A, which is a significant health burden in Korea.

  11. Diagnostic Strategies for Early Lynch Syndrome Detection: From Molecular Testing to Economic Evaluation

    NARCIS (Netherlands)

    C.H.M. Leenen (Celine)

    2015-01-01

    markdownabstract__Abstract__ Lynch syndrome (LS) is an autosomal dominant inherited syndrome that predisposes to multiple malignancies, in particular colorectal cancer (CRC) and endometrial cancer (EC). The lifetime risk of developing CRC for a LS mutation carrier is 25 to 70%, while women

  12. A ZVS PWM control strategy with balanced capacitor current for half-bridge three-level DC/DC converter

    DEFF Research Database (Denmark)

    Liu, Dong; Deng, Fujin; Chen, Zhe

    2017-01-01

    The capacitor current would be imbalanced under the conventional control strategy in the half-bridge three-level (HBTL) DC/DC converter due to the effect of the output inductance of the power supply and the input line inductance, which would affect the converter's reliability. This paper proposes...... a pulse-wide modulation (PWM) strategy composed of two operation modes for the HBTL DC/DC converter, which can realize the zero-voltage switching (ZVS) for the efficiency improvement. In addition, a capacitor current balancing control is proposed by alternating the two operation modes of the proposed ZVS...... PWM strategy, which can eliminate the current imbalance among the two input capacitors. Therefore, the proposed control strategy can improve the converter's performance and reliability in: 1) reducing the switching losses and noises of the power switches; 2) balancing the thermal stresses...

  13. CURRENT APPROACHES TO THERAPY OF RETT’S SYNDROME (A REVIEW OF LITERATURE

    Directory of Open Access Journals (Sweden)

    N. Yu. Borovikova

    2015-01-01

    Full Text Available Antiepileptic therapy is one of the most urgent problems in the treatment of Rett’s syndrome. By taking into account a common concurrence of generalized and focal seizures with diffuse epileptiform activity on the electroencephalogram (EEG in Rett’s syndrome, there are effective broad-spectrum antiepileptic drugs (AEDs: valproates, topiramate, levetiracetam, lamotrigine. Carbamazepine is effective for focal seizures and in the absence of diffuse EEG changes. For atypical absences, ethosuximide may be added to valproates, topiramate, or levetiracetam. Reflex seizures show a high resistance; their frequency is occasionally reduced by AEDs in combination with neuroleptics. Sleep hygiene, as well as medication (clonidine, zolpidem, trazodone, melatonin, risperidone are recommended to correct various sleep disorders. Dopamine agonists, as well as L-carnitine are used for the drug correction of movement disorders in Rett’s syndrome. Therapeutic exercises are one of the most optimal ways to correct movement disorders. Orthopedic correction, including surgery, is indicated for skeletal deformities. Vitamin D used for long periods of time is beneficial, by considering its deficiency and osteoporosis at a fracture risk in Rett’s syndrome patients who receive AEDs particularly long. A special high-fat diet and a fractional diet in small portions are used in the therapy of cachexia and growth retardation due to oral dysfunction and malnutrition. A cardiological follow-up is needed in abnormalities, such as prolonged Q interval, tachyarrhythmia, and cardiac structural anomalies. Systematic learning to maintain communication and motor skills are of importance. In this case a special role is played by music therapy that exerts a calming effect on patients and partially compensates for loss of contact with the environment.

  14. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    OpenAIRE

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imagin...

  15. Current Diagnosis and Treatment Models of Periodic Fever, Aphthous Stomatitis, Pharyngitis and Cervical Lymphadenitis Syndrome

    Directory of Open Access Journals (Sweden)

    Ayşenur Paç Kısaarslan

    2017-06-01

    Full Text Available Periodic fever, aphthous stomatitis, pharyngitis, and cervical lymphadenitis (PFAPA syndrome is the most frequent cause of periodic fever in childhood. The pathogenesis of PFAPA is still unknown. Differantial diagnosis must be made with cyclic neutropenia and other autoinflammatory diseases. Because PFAPA is self limiting and benign, there is no certain treatment model. Treatment options must be specific to the patient, with a strong family and doctor relationship.

  16. Early diagnosis of amyotrophic lateral sclerosis mimic syndromes: pros and cons of current clinical diagnostic criteria.

    Science.gov (United States)

    Cortés-Vicente, Elena; Pradas, Jesús; Marín-Lahoz, Juan; De Luna, Noemi; Clarimón, Jordi; Turon-Sans, Janina; Gelpí, Ellen; Díaz-Manera, Jordi; Illa, Isabel; Rojas-Garcia, Ricard

    2017-08-01

    To describe the frequency and clinical characteristics of patients referred to a tertiary neuromuscular clinic as having amyotrophic lateral sclerosis (ALS) but who were re-diagnosed as having an ALS mimic syndrome, and to identify the reasons that led to the revision of the diagnosis. We reviewed the final diagnosis of all patients prospectively registered in the Sant Pau-MND register from 1 January 2004 to 31 December 2015. A detailed clinical evaluation and a clinically-guided electrophysiological study were performed at first evaluation. Twenty of 314 (6.4%) patients included were re-diagnosed as having a condition other than ALS, in 18 cases already at first evaluation. An alternative specific diagnosis was identified in 17 of those 20, consisting of a wide range of conditions. The main finding leading to an alternative diagnosis was the result of the electrophysiological study. Fifty per cent did not fulfil the El Escorial revised criteria (EECr) for ALS. The most common clinical phenotype at onset in patients with ALS mimic syndromes was progressive muscular atrophy (PMA). Misdiagnosing ALS is still a common problem. Early identification of ALS mimic syndromes is possible based on atypical clinical features and a clinically-guided electrophysiological study. Patients should be attended in specialised centres. The application of EECr helps to identify ALS misdiagnoses.

  17. Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Son V Pham

    2010-09-01

    Full Text Available Son V Pham1, Phuong-Chi T Pham2, Phuong-Mai T Pham3, Jeffrey M Miller4, Phuong-Thu T Pham5, Phuong-Anh T Pham61Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA; 2Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, 3Department of Medicine, Greater Los Angeles VA Medical Center, 4Department of Medicine, Hematology-Oncology Division, UCLA-Olive View Medical Center, 5Department of Medicine, Nephrology Division, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 6Mercy General Hospital, Heart and Vascular Institute, Department of Cardiology, Sacramento, CA, USAAbstract: In patients undergoing percutaneous coronary intervention (PCI for acute coronary syndrome (ACS, both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients

  18. Water Utility Management Strategies in Turkey: The current situation and the challenges

    Science.gov (United States)

    Alp, E.; Aksoy, M. N.; Koçer, B.

    2013-12-01

    As the effects of climate change becomes more prominent, current challenges related to water and wastewater management is becoming more serious. Providing water that satisfies environmental and safety standards in terms of quantity and quality is needed to maintain human life without compromising the need of future generations. Besides providing safe and affordable water, necessary treatment should be achieved according to several important factors such as receiving body standards, discharge standards, water reuse options. Therefore, management of water becomes more crucial than ever that states have to provide accessibility of safe water with affordable cost to its citizens with the means of effective utility management, including water treatment facilities, wastewater treatment facilities, water supply facilities and water distribution systems. Water utilities encounter with several challenges related to cost, infrastructure, population, legislation, workforce and resource. This study aims to determine the current situation and the necessary strategies to improve utility management in Turkish municipalities in a sustainable manner. US Environment Protection Agency (EPA) has formed a tool on effective utility management that assists utilities to provide a solution for both current and future challenges. In this study, we used EPA's guidelines and developed a survey consists of 60 questions under 10 sub-topics (Product Quality, Employee & Leadership Development, Stakeholder Understanding & Support, Operational Optimization, Infrastructure Stability, Financial Viability, Community Sustainability, Customer Satisfaction, Operational Resiliency, and Water Resource Adequacy). This survey was sent to the managers of 25 metropolitan municipalities in Turkey to assess the current condition of municipalities. After the evaluation of the survey results for each topic, including the importance given by managers, facilities were rated according to their level of achievement

  19. Analysis and Design of Improved Weighted Average Current Control Strategy for LCL-Type Grid-Connected Inverters

    DEFF Research Database (Denmark)

    Han, Yang; Li, Zipeng; Yang, Ping

    2017-01-01

    The LCL grid-connected inverter has the ability to attenuate the high-frequency current harmonics. However, the inherent resonance of the LCL filter affects the system stability significantly. To damp the resonance effect, the dual-loop current control can be used to stabilize the system. The grid...... Control Strategy for LCL-Type Grid-Connected Inverters. Available from: https://www.researchgate.net/publication/313734269_Analysis_and_Design_of_Improved_Weighted_Average_Current_Control_Strategy_for_LCL-Type_Grid-Connected_Inverters [accessed Apr 20, 2017]....... current plus capacitor current feedback system is widely used for its better transient response and high robustness against the grid impedance variations. While the weighted average current (WAC) feedback scheme is capable to provide a wider bandwidth at higher frequencies but show poor stability...

  20. Improvement Strategies, Cost Effective Production, and Potential Applications of Fungal Glucose Oxidase (GOD: Current Updates

    Directory of Open Access Journals (Sweden)

    Manish K. Dubey

    2017-06-01

    Full Text Available Fungal glucose oxidase (GOD is widely employed in the different sectors of food industries for use in baking products, dry egg powder, beverages, and gluconic acid production. GOD also has several other novel applications in chemical, pharmaceutical, textile, and other biotechnological industries. The electrochemical suitability of GOD catalyzed reactions has enabled its successful use in bioelectronic devices, particularly biofuel cells, and biosensors. Other crucial aspects of GOD such as improved feeding efficiency in response to GOD supplemental diet, roles in antimicrobial activities, and enhancing pathogen defense response, thereby providing induced resistance in plants have also been reported. Moreover, the medical science, another emerging branch where GOD was recently reported to induce several apoptosis characteristics as well as cellular senescence by downregulating Klotho gene expression. These widespread applications of GOD have led to increased demand for more extensive research to improve its production, characterization, and enhanced stability to enable long term usages. Currently, GOD is mainly produced and purified from Aspergillus niger and Penicillium species, but the yield is relatively low and the purification process is troublesome. It is practical to build an excellent GOD-producing strain. Therefore, the present review describes innovative methods of enhancing fungal GOD production by using genetic and non-genetic approaches in-depth along with purification techniques. The review also highlights current research progress in the cost effective production of GOD, including key advances, potential applications and limitations. Therefore, there is an extensive need to commercialize these processes by developing and optimizing novel strategies for cost effective GOD production.

  1. Current Status of Air Toxics Management and Its Strategies for Controlling Emissions in Taiwan

    Directory of Open Access Journals (Sweden)

    Wen-Tien Tsai

    2016-04-01

    Full Text Available Since the 1970s, hazardous air pollutants (HAPs, so-called air toxics, have been of great concern because they can cause serious human health effects and have adverse effects on the environment. More noticeably, some of them are known to be human carcinogens. The objective of this paper is to investigate the regulatory systems and human health effects of air toxics which have been designated by the Taiwan government under the Air Pollution Control Act. These toxic air pollutants include acutely toxic gas (i.e., ammonia, chlorine, fluorides, hydrochloric acid, hydrogen cyanide, hydrogen sulfide, nitric acid, phosphoric acid and sulfuric acid, gas containing heavy metals, and carcinogenic chemicals (including formaldehyde, vinyl chloride, asbestos and matter containing asbestos, dioxins and furans, volatile organic compounds, polycyclic aromatic hydrocarbons, and polychlorinated biphenyls. In line with international concern about the carcinogenic risk and environmental persistence of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDDs/PCDFs and heavy metals in recent years, the current status in monitoring and reducing the emissions of PCDDs/PCDFs from stationary sources was analyzed as a case study in the present study. Furthermore, the control strategies for reducing emissions of air toxics from stationary sources in Taiwan were also addressed.

  2. A review of treatment strategies for hydrofluoric acid burns: current status and future prospects.

    Science.gov (United States)

    Wang, Xingang; Zhang, Yuanhai; Ni, Liangfang; You, Chuangang; Ye, Chunjiang; Jiang, Ruiming; Liu, Liping; Liu, Jia; Han, Chunmao

    2014-12-01

    Hydrofluoric acid (HF), a dangerous inorganic acid, can cause severe corrosive effects and systemic toxicity. HF enters the human body via where it contacts, such as skin and mucosa, alimentary and respiratory tracts, and ocular surfaces. In the recent years, the incidence of HF burn has tended to increase over time. The injury mechanism of HF is associated primarily with the massive absorption of HF and the release of hydrogen ions. Correct diagnosis and timely treatment are especially important for HF burns. The critical procedure to treat HF burn is to prevent on-going HF absorption, and block the progressive destruction caused by fluoride ions. Due to the distinct characteristics of HF burns, the topical treatment, as well as systemic support, has been emphasised. Whereas, management of patients with HF burns remains a great challenge in some situations. To date, there has been no widely accepted protocol for the rescue of HF burns, partly due to the diversity of HF burns. This paper overviews the current status and problems of treatment strategies for HF burns, for the purpose of promoting the future researches and improvement. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  3. Current therapeutic strategies of anti-HER2 treatment in advanced breast cancer patients

    Directory of Open Access Journals (Sweden)

    Joanna Huszno

    2016-03-01

    Full Text Available The HER2/neu ( ERBB2 oncogene is amplified and/or overexpressed in approximately 20% of breast cancers, and is a strong prognostic factor for relapse and poor overall survival, particularly in node-positive patients. It is also an important predictor for response to trastuzumab, which has established efficacy against breast cancer with overexpression or amplification of the HER2 oncogene. Treatment with the anti-HER2 humanized monoclonal antibody – trastuzumab significantly improves progression-free and overall survival among patients with HER2-positive breast cancer. However, in most patients with HER2-positive metastatic breast cancer, the disease progresses occurred, what cause the need for new targeted therapies for advanced disease. In clinical trials, there are tested new drugs to improve the results of treatment for this group of patients. This paper presents new drugs introduced into clinical practice for treatment of advanced breast cancer, whose molecular target are receptors of the HER2 family. In addition, new therapeutic strategies and drugs that are currently in clinical researches are discussed.

  4. Current strategies in multiphasic scaffold design for osteochondral tissue engineering: A review.

    Science.gov (United States)

    Yousefi, Azizeh-Mitra; Hoque, Md Enamul; Prasad, Rangabhatala G S V; Uth, Nicholas

    2015-07-01

    The repair of osteochondral defects requires a tissue engineering approach that aims at mimicking the physiological properties and structure of two different tissues (cartilage and bone) using specifically designed scaffold-cell constructs. Biphasic and triphasic approaches utilize two or three different architectures, materials, or composites to produce a multilayered construct. This article gives an overview of some of the current strategies in multiphasic/gradient-based scaffold architectures and compositions for tissue engineering of osteochondral defects. In addition, the application of finite element analysis (FEA) in scaffold design and simulation of in vitro and in vivo cell growth outcomes has been briefly covered. FEA-based approaches can potentially be coupled with computer-assisted fabrication systems for controlled deposition and additive manufacturing of the simulated patterns. Finally, a summary of the existing challenges associated with the repair of osteochondral defects as well as some recommendations for future directions have been brought up in the concluding section of this article. © 2014 Wiley Periodicals, Inc.

  5. Vietnam's energy sector: A review of current energy policies and strategies

    International Nuclear Information System (INIS)

    Tien Minh Do; Sharma, Deepak

    2011-01-01

    Since the introduction of market-oriented economy in 1986, Vietnam has made noticeable socio-economic progress. In this progress, the energy sector has played a vital role. This role is likely to deepen in the years to come as Vietnam strives to achieve even higher levels in economic progress. Such deepening in the role of energy, this paper argues, will heighten concerns about the security of energy supply, and economic, environmental, social and political consequences. In order to address these issues, Vietnam has over the last decade, developed a suite of energy policies. A deeper review of these policies suggests that they are typified by economic-growth orientation, exclusive focus on a single-sector or single issue, and largely neglect the significance of cross-sectoral and cross-thematic issues arising from the interdependencies between energy, economy, and the polity at large. The existing energy policy settings are, therefore, unlikely to be able to provide a satisfactory redress to the challenges noted above. This paper provides an overview of the current energy policies with a view to identify areas where further policy effort is needed in order to facilitate a sustainable development of the Vietnamese energy sector. - Highlights: → Identifying challenges faced by the Vietnamese energy sector. → Analyzing limitations of the existing energy policy settings (policies, strategies and institutions) in addressing these challenges. → Developing recommendations on improving the existing energy policy settings to provide a satisfactory redress for the challenges noted above.

  6. Energy service companies in European countries: Current status and a strategy to foster their development

    Energy Technology Data Exchange (ETDEWEB)

    Bertoldi, Paolo [European Commission, DG JRC, TP 450, I-21020 Ispra (Vatican City State, Holy See,) (Italy)]. E-mail: paolo.bertoldi@cec.eu.int; Rezessy, Silvia [Department of Environmental Sciences and Policy, Central European University, Nador u. 9, H-1051 Budapest (Hungary)]. E-mail: ephlas01@phd.ceu.hu; Vine, Edward [Lawrence Berkeley National Laboratory, Building 90-4000, Berkeley, CA 94720 (United States)]. E-mail: elvine@lbl.gov

    2006-09-15

    Although the European Commission and the Member States of the European Union (EU) have promoted a number of policy initiatives to foster the Energy Services Company (ESCO) industry, a recent survey of ESCO businesses in Europe has indicated that major differences exist in the development of the ESCO business among the various countries. In some countries a large number of ESCOs have been successfully operating for a number of years, while in other countries only a few ESCOs have recently started to operate. This difference could be explained by several factors, such as different levels of support offered to ESCOs by national and regional energy authorities, local market structures and rules, and variation in the definitions, roles and activities of ESCOs. This paper reviews and analyses the development and the current status of ESCO industries in the EU and the New Accession Countries. Based on the review and the analysis, a long-term strategy to foster the development of ESCOs in Europe is formulated. The strategic actions recommended build on successful experience in Europe and are proposed with an eye to existing and planned legislative measures, such as the proposed Energy Service Directive and the deployment of the Kyoto flexible mechanisms.

  7. Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

    Directory of Open Access Journals (Sweden)

    Harmon CM

    2017-04-01

    Full Text Available Charles M Harmon, Laura L Cooling Department of Pathology, University of Michigan, Ann Arbor, MI, USA Abstract: Cytomegalovirus (CMV is a pervasive DNA virus that infects a significant portion of individuals worldwide, and may be transmitted through the transfusion of blood products. Although CMV infection is of little consequence in immunocompetent individuals, patients with an impaired immune system are at risk of significant morbidity and mortality. Unlike other blood-borne infectious agents, it is impractical to defer all CMV-positive individuals from blood donation as this would exclude a substantial number of otherwise eligible donors. Other methods such as transfusion of CMV-seronegative and leukoreduced blood products must be employed to prevent the transmission of CMV to at-risk patients. In this study, the widespread use of current strategies for the prevention of transfusion-transmitted CMV (TT-CMV infection and the evidence to support these methods in various at-risk groups were reviewed. In addition, emerging pathogen inactivation technologies that have the potential to eliminate TT-CMV were also discussed. Keywords: blood transfusion, cytomegalovirus, leukoreduction, pathogen inactivation, hematopoietic stem cell transplantation, very low birth weight infants

  8. Energy service companies in European countries: Current status and a strategy to foster their development

    International Nuclear Information System (INIS)

    Bertoldi, Paolo; Rezessy, Silvia; Vine, Edward

    2006-01-01

    Although the European Commission and the Member States of the European Union (EU) have promoted a number of policy initiatives to foster the Energy Services Company (ESCO) industry, a recent survey of ESCO businesses in Europe has indicated that major differences exist in the development of the ESCO business among the various countries. In some countries a large number of ESCOs have been successfully operating for a number of years, while in other countries only a few ESCOs have recently started to operate. This difference could be explained by several factors, such as different levels of support offered to ESCOs by national and regional energy authorities, local market structures and rules, and variation in the definitions, roles and activities of ESCOs. This paper reviews and analyses the development and the current status of ESCO industries in the EU and the New Accession Countries. Based on the review and the analysis, a long-term strategy to foster the development of ESCOs in Europe is formulated. The strategic actions recommended build on successful experience in Europe and are proposed with an eye to existing and planned legislative measures, such as the proposed Energy Service Directive and the deployment of the Kyoto flexible mechanisms

  9. Vietnam's energy sector: A review of current energy policies and strategies

    Energy Technology Data Exchange (ETDEWEB)

    Tien Minh Do, E-mail: tmdo@eng.uts.edu.au [Hanoi University of Science and Technology (HUST), 1 Dai Co Viet Street, Hai Ba Trung District, Hanoi (Viet Nam); Sharma, Deepak [University of Technology, Sydney (UTS), Broadway, Ultimo, NSW 2007 (Australia)

    2011-10-15

    Since the introduction of market-oriented economy in 1986, Vietnam has made noticeable socio-economic progress. In this progress, the energy sector has played a vital role. This role is likely to deepen in the years to come as Vietnam strives to achieve even higher levels in economic progress. Such deepening in the role of energy, this paper argues, will heighten concerns about the security of energy supply, and economic, environmental, social and political consequences. In order to address these issues, Vietnam has over the last decade, developed a suite of energy policies. A deeper review of these policies suggests that they are typified by economic-growth orientation, exclusive focus on a single-sector or single issue, and largely neglect the significance of cross-sectoral and cross-thematic issues arising from the interdependencies between energy, economy, and the polity at large. The existing energy policy settings are, therefore, unlikely to be able to provide a satisfactory redress to the challenges noted above. This paper provides an overview of the current energy policies with a view to identify areas where further policy effort is needed in order to facilitate a sustainable development of the Vietnamese energy sector. - Highlights: > Identifying challenges faced by the Vietnamese energy sector. > Analyzing limitations of the existing energy policy settings (policies, strategies and institutions) in addressing these challenges. > Developing recommendations on improving the existing energy policy settings to provide a satisfactory redress for the challenges noted above.

  10. Assessment of Current Knowledge about the Effectiveness of School Desegregation Strategies. Volume II: An Agenda for Further Research on Desegregation Strategies.

    Science.gov (United States)

    Crain, Robert L.; Hawley, Willis D.

    This paper agrees that there are inadequacies in school desegregation research and suggests strategies for improving its quality and availability as well as improving current educational policies. It is suggested that the interaction of power and resources determines the post-desegregation changes in school policies. The effects of desegregation…

  11. [Current options of insulin resistence correction in patients with metabolic syndrome].

    Science.gov (United States)

    Demidova, T Iu; Ametov, A S; Titova, O I

    2006-01-01

    To study thiasolidindion drug pioglitazone for efficacy in metabolic syndrome (MS). Twenty patients with MS were examined at baseline and after 12 week therapy with pioglitazone. The examination included estimation of fasting and postprandial glycemia, insulin resistance index, HOMA-IR index, HbAlc, lipid profile, microalbuminuria (MAU), blood pressure, endothelium-related vasodilation. Pioglitazone therapy for 12 weeks significantly reduced HbAlc, fasting and postprandial glycemia, insulinemia, HOMA-IR, improved blood lipid spectrum, reduced visceral obesity. Positive effects were also achieved on blood pressure, MAU and endothelium-related vasodilation.

  12. Clinical features and pathophysiology of Complex Regional Pain Syndromecurrent state of the art

    Science.gov (United States)

    Marinus, Johan; Moseley, G. Lorimer; Birklein, Frank; Baron, Ralf; Maihöfner, Christian; Kingery, Wade S.; van Hilten, Jacobus J.

    2017-01-01

    That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS. PMID:21683929

  13. Endovascular Repair of Aortic Dissection in Marfan Syndrome: Current Status and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Rosario Parisi

    2015-07-01

    Full Text Available Over the last decades, improvement of medical and surgical therapy has increased life expectancy in Marfan patients. Consequently, the number of such patients requiring secondary interventions on the descending thoracic aorta due to new or residual dissections, and distal aneurysm formation has substantially enlarged. Surgical and endovascular procedures represent two valuable options of treatment, both associated with advantages and drawbacks. The aim of the present manuscript was to review endovascular outcomes in Marfan syndrome and to assess the potential role of Thoracic Endovascular Aortic Repair (TEVAR in this subset of patients.

  14. Coordination of Project and Current Activities on the Basis of the Strategy Alignment Metamodel in the Oil and Gas Company

    Directory of Open Access Journals (Sweden)

    R. Yu. Dashkov

    2017-01-01

    Full Text Available Purpose: the purpose of this article is to describe the Strategy Alignment Metamodel of the project and current activities, which allows us to connect the Goals and Strategies for Phases of the project with the Goals and Strategies of the company at all levels of the organization through targeted measurement and application of Interpretive Models. Building Networks of Goals and Strategies, and adopting organizational solutions, you coordinate the interaction of the Project office and departments of the company. This methodology is based on a Logical Rationale of the Contexts and Assumptions for establishing Goals and Strategies both for the project and for the company, and on preparation of Contexts and Assumptions, Goals and Strategies Alignment Matrices, which provides a flexible adaptation to the internal and external environment in the process of selecting the most successful Strategies to achieve the Goals. Methods: this article is based on the concept of Goals-Questions-Metrics+ Strategies, which is adapted as another concept of strategic monitoring and control system of projects: Goals-Phases-Metrics+Strategies. These concepts have formed the basis of the Strategy Alignment Metamodel, where a technology of Phases Earned Value Management is used as a measurement system for the project activity, and Balanced scorecard is applied for current operations. Results: strategy Alignment Metamodel of the project and current activities of the company is proposed hereby. It uses modern strategic monitoring and control systems for projects: Goals-Phases-Metrics+Strategies, and for the company: Goals-Questions-Metrics+ Strategies. The interaction between these systems is based on Contexts and Assumptions, Goals and Strategies Alignment Matrices. The existence of such matrices greatly simplifies management decisions and prevents the risk of delays in the execution of project Phases based on rational participation and coordination of the company

  15. Modeling of novel diagnostic strategies for active tuberculosis - a systematic review: current practices and recommendations.

    Directory of Open Access Journals (Sweden)

    Alice Zwerling

    Full Text Available The field of diagnostics for active tuberculosis (TB is rapidly developing. TB diagnostic modeling can help to inform policy makers and support complicated decisions on diagnostic strategy, with important budgetary implications. Demand for TB diagnostic modeling is likely to increase, and an evaluation of current practice is important. We aimed to systematically review all studies employing mathematical modeling to evaluate cost-effectiveness or epidemiological impact of novel diagnostic strategies for active TB.Pubmed, personal libraries and reference lists were searched to identify eligible papers. We extracted data on a wide variety of model structure, parameter choices, sensitivity analyses and study conclusions, which were discussed during a meeting of content experts.From 5619 records a total of 36 papers were included in the analysis. Sixteen papers included population impact/transmission modeling, 5 were health systems models, and 24 included estimates of cost-effectiveness. Transmission and health systems models included specific structure to explore the importance of the diagnostic pathway (n = 4, key determinants of diagnostic delay (n = 5, operational context (n = 5, and the pre-diagnostic infectious period (n = 1. The majority of models implemented sensitivity analysis, although only 18 studies described multi-way sensitivity analysis of more than 2 parameters simultaneously. Among the models used to make cost-effectiveness estimates, most frequent diagnostic assays studied included Xpert MTB/RIF (n = 7, and alternative nucleic acid amplification tests (NAATs (n = 4. Most (n = 16 of the cost-effectiveness models compared new assays to an existing baseline and generated an incremental cost-effectiveness ratio (ICER.Although models have addressed a small number of important issues, many decisions regarding implementation of TB diagnostics are being made without the full benefits of insight from mathematical

  16. Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

    DEFF Research Database (Denmark)

    Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita

    2013-01-01

    The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

  17. Current status of prenatal diagnosis in Cuba: causes of low prevalence of Down syndrome.

    Science.gov (United States)

    Méndez-Rosado, L A; Hechavarría-Estenoz, D; de la Torre, M E; Pimentel-Benitez, H; Hernández-Gil, J; Perez, B; Barrios-Martínez, A; Morales-Rodriguez, E; Soriano-Torres, M; Garcia, M; Suarez-Mayedo, U; Cedeño-Aparicio, N; Blanco, I; Díaz-Véliz, P; Vidal-Hernández, B; Mitjans-Torres, M; Miñoso, S; Alvarez-Espinosa, D; Reyes-Hernández, E; Angulo-Cebada, E; Torres-Palacios, M; Lozano-Lezcano, L; Lima-Rodriguez, U; Mayeta, M; Noblet, M; Benítez, Y; Lardoeyt-Ferrer, R; Yosela-Martin, S; Carbonell, P; Pérez-Ramos, M; de León, N; Perez, M; Carbonell, J

    2014-11-01

    To analyze trends in cytogenetic prenatal diagnosis in Cuba and to analyze possible causes leading to a low Down syndrome prevalence in a country where the triple test is not available. An analysis of the Cuban program in prenatal cytogenetic diagnosis from 1984 to 2012 was conducted. Results are described, with particular emphasis on indications, abnormal results, types of invasive procedures, and terminations of pregnancy. Cytogenetic prenatal diagnostic analyses (n = 75,095) were conducted; maternal age was the indication for 77.9% of the amniocenteses and chorionic villus samplings. The detection rate of chromosomally abnormal pregnancies was 2.3% for maternal age and increased to 8-9% for other indications. When a chromosomal abnormality was identified, 88.5% terminated the pregnancy. In 2002, the live birth prevalence of Down syndrome was 8.4 per 10,000 live births, and in 2012, 7 per 10,000. Prenatal diagnosis in Cuba has contributed to a significant reduction in chromosomal aberrations. The impact increased because of the demographic trends of the population, the high index of terminations of pregnancy, and the establishment of a network of cytogenetic laboratories throughout Cuba. © 2014 John Wiley & Sons, Ltd.

  18. Current trends in the treatment of polycystic ovary syndrome with desire for children

    Directory of Open Access Journals (Sweden)

    Margalida E Sastre

    2009-05-01

    Full Text Available Margalida E Sastre1, Maria O Prat1, Miguel Angel Checa1,2, Ramon C Carreras11Department of Obstetrics and Gynaecology; 2Unit of Endocrinological Gynaecology and Human Reproduction, Hospital del Mar, Autonomous University of Barcelona, Barcelona, SpainAbstract: Polycystic ovary syndrome (PCOS, one of the most frequent endocrine diseases, affects approximately 5%–10% of women of childbearing age and constitutes the most common cause of female sterility regardless of the need or not for treatment, a change in lifestyle is essential for the treatment to work and ovulation to be restored. Obesity is the principal reason for modifying lifestyle since its reduction improves ovulation and the capacity for pregnancy and lowers the risk of miscarriage and later complications that may occur during pregnancy (gestational diabetes, pre-eclampsia, etc. When lifestyle modification is not sufficient, the first step in ovulation induction is clomiphene citrate. The second-step recommendation is either exogenous gonadotrophins or laparoscopic ovarian surgery. Recommended third-line treatment is in vitro fertilization. Metformin use in PCOS should be restricted to women with glucose intolerance.Keywords: polycystic ovarian syndrome, clomiphene citrate, letrozole, lifestyle, pregnancy, obesity 

  19. Current Issues and Challenges in the Use of Aerosolized Surfactant for Respiratory Distress Syndrome in the Newborns

    Directory of Open Access Journals (Sweden)

    Dion Darius Samsudin

    2013-08-01

    Full Text Available BACKGROUND: Surfactant replacement therapy is a recognized treatment for respiratory distress syndrome (RDS in the newborns. Over the past 30 years, human and animal trials have been performed regarding administration of aerosolized surfactant to the injured lung, however the result has been unsatisfactory when compared with instilled surfactant delivery via endotracheal tube (ETT. This review aims to investigate the current issues, challenges and future recommendation of aerosolized surfactant therapy. CONTENT: Five randomized clinical trials in humans and 13 animal trials met the inclusion criteria and were reviewed. Most animal trials agree that this method of treatment is feasible. However, human trials presented conflicting results, and generally showed it to be ineffective. When compared with surfactant delivery via ETT, aerosolized surfactant is less effective in improving respiratory function. SUMMARY: The current data from human trials does not support the implementation of aerosolized surfactant therapy to treat newborns with RDS. Further research is necessary to improve nebulization, delivery, distribution and deposition in the lung, to investigate aerosolized surfactant delivery via ETT and to determine the appropriate dose. KEYWORDS: surfactant, aerosol, prematurity, respiratory distress syndrome.

  20. Strategies for the Use of Tidal Stream Currents for Power Generation

    Science.gov (United States)

    Orhan, Kadir; Mayerle, Roberto

    2015-04-01

    Indonesia is one of the priority countries in Southeast Asia for the development of ocean renewable energy facilities and The National Energy Council intends to increase the role of ocean energy significantly in the energy mix for 2010-2050. To this end, the joint German-Indonesian project "Ocean Renewable Energy ORE-12" aims at the identification of marine environments in the Indonesian Archipelago, which are suitable for the efficient generation of electric power by converter facilities. This study, within the ORE-12 project, is focused on the tidal stream currents on the straits between the Indian Ocean and Flores Sea to estimate the energy potentials and to develop strategies for producing renewable energy. FLOW module of Delft3D has been used to run hydrodynamic models for site assessment and design development. In site assessment phase, 2D models have been operated for a-month long periods and with a resolution of 500 m. Later on, in design development phase, detailed 3D models have been developed and operated for three-month long periods and with a resolution of 50 m. Bathymetric data for models have been obtained from the GEBCO_08 Grid and wind data from the Global Forecast System of NOAA's National Climatic Data Center. To set the boundary conditions of models, tidal forcing with 11 harmonic constituents was supplied from TPXO Indian Ocean Atlas (1/12° regional model) and data from HYCOM+NCODA Global 1/12° Analysis have been used to determine salinity and temperature on open boundaries. After the field survey is complete, water level time-series supplied from a tidal gauge located in the domain of interest (8° 20΄ 9.7" S, 122° 54΄ 51.9" E) have been used to verify the models and then energy potentials of the straits have been estimated. As a next step, correspondence between model outputs and measurements taken by the radar system of TerraSAR-X satellite (DLR) will be analysed. Also for the assessment of environmental impacts caused by tidal stream

  1. Gender identity disorders in childhood and adolescence: currently debated concepts and treatment strategies.

    Science.gov (United States)

    Korte, Alexander; Lehmkuhl, Ulrike; Goecker, David; Beier, Klaus Michael; Krude, Heiko; Grüters-Kieslich, Annette

    2008-11-01

    Gender identity disorders (GID) can appear even in early infancy with a variable degree of severity. Their prevalence in childhood and adolescence is below 1%. GID are often associated with emotional and behavioral problems as well as a high rate of psychiatric comorbidity. Their clinical course is highly variable. There is controversy at present over theoretical explanations of the causes of GID and over treatment approaches, particularly with respect to early hormonal intervention strategies. This review is based on a selective Medline literature search, existing national and international guidelines, and the results of a discussion among experts from multiple relevant disciplines. As there have been no large studies to date on the course of GID, and, in particular, no studies focusing on causal factors for GID, the evidence level for the various etiological models that have been proposed is generally low. Most models of these disorders assume that they result from a complex biopsychosocial interaction. Only 2.5% to 20% of all cases of GID in childhood and adolescence are the initial manifestation of irreversible transsexualism. The current state of research on this subject does not allow any valid diagnostic parameters to be identified with which one could reliably predict whether the manifestations of GID will persist, i.e., whether transsexualism will develop with certainty or, at least, a high degree of probability. The types of modulating influences that are known from the fields of developmental psychology and family dynamics have therapeutic implications for GID. As children with GID only rarely go on to have permanent transsexualism, irreversible physical interventions are clearly not indicated until after the individual's psychosexual development ist complete. The identity-creating experiences of this phase of development should not be restricted by the use of LHRH analogues that prevent puberty.

  2. Virtual resistance-based control strategy for DC link regeneration protection and current sharing in uninterruptible power supply

    DEFF Research Database (Denmark)

    Lu, Jinghang; Guan, Yajuan; Savaghebi, Mehdi

    2017-01-01

    To address the DC link voltage regeneration issue in parallel Uninterruptible Power Supply (UPS) system, a DC link voltage protection (DCVP) method through online virtual resistance regulation is proposed. The proposed control strategy is able to protect the DC link from overvoltage that may...... trigger the protection mechanism of the UPS system. Moreover, a current sharing control strategy by regulating the virtual resistance is proposed to address the circulating current caused by the active power feeding. Finally, the feasibility of the proposed method is verified by experimental results from...

  3. The syndrome of inappropriate antidiuretic hormone: current and future management options.

    LENUS (Irish Health Repository)

    Sherlock, Mark

    2010-06-01

    Hyponatraemia is the commonest electrolyte abnormality, and syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent underlying pathophysiology. Hyponatraemia is associated with significant morbidity and mortality, and as such appropriate treatment is essential. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide and saline infusion, all of which have their limitations. The introduction of the vasopressin-2 receptor antagonists has allowed clinicians to specifically target the underlying pathophysiology of SIADH. Initial studies have shown good efficacy and safety profiles in the treatment of mild to moderate hyponatraemia. However, studies assessing the efficacy and safety of these agents in acute severe symptomatic hyponatraemia are awaited. Furthermore, the cost of these agents at present may limit their use.

  4. Diagnosis and treatments of Prader-Willi syndrome: a review of current consensuses

    Directory of Open Access Journals (Sweden)

    2014-05-01

    Full Text Available We analyzed international consensuses of experts and clinical recommendations on diagnosis and treatment of Prader-Willi syndrome (PWS: PWS consensus diagnostic criteria (1993; US PWS Association (PWSA-USA consensus statements on evaluating of breathing abnormalities (2007, osteoporosis (2008, growth hormone treatment in PWS (2000 and 2009; Endocrine society clinical practice guideline on Prevention and treatment of pediatric obesity (2008; the Second Expert Meeting of the Comprehensive Care of Patients with PWS Consensus published as Recommendations for the diagnosis and management of PWS (2008. Historical analysis and comparison of recommendations are presented in this review article. Absence of Russian clinical practice guidelines on PWS patients management makes necessary the detailed study of listed documents.

  5. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights

    Directory of Open Access Journals (Sweden)

    Kinsinger SW

    2017-07-01

    Full Text Available Sarah W Kinsinger Behavioral Medicine for Digestive Health, Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL, USA Abstract: Irritable bowel syndrome (IBS is a chronic gastrointestinal (GI condition associated with significant health care utilization and quality-of-life impairment. Latest research indicates that the brain–gut axis plays a key role in the disorder, and the presence of psychological factors and central processing deficits contribute to symptom severity and disability. Psychological therapies as a whole have demonstrated good efficacy in reducing the severity of IBS symptoms. Cognitive-behavioral therapy (CBT has been tested most rigorously in multiple randomized controlled trials and consistently demonstrates significant and durable effects on IBS symptoms and quality of life. Various protocols for treating IBS have been developed, and most recent advances in the field include exposure-based treatments to target symptom-specific anxiety as well as modified delivery methods, including internet-based treatment models. Despite the well-documented advantages of CBT for IBS, it has been poorly disseminated and few patients have access to this treatment. The primary barrier to dissemination is the limited number of therapists with adequate training in GI psychology to provide this evidence-based intervention. Future developments in the field need to focus on training opportunities to equip more therapists to competently provide CBT for this population. Further efforts to develop telemedicine platforms for delivering this intervention will also improve accessibility for patients. Keywords: irritable bowel syndrome, functional gastrointestinal disorders, cognitive-behavioral therapy

  6. The effects of neuromuscular taping on gait walking strategy in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type

    Science.gov (United States)

    Camerota, Filippo; Galli, Manuela; Celletti, Claudia; Ancillao, Andrea; Blow, David; Albertini, Giorgio

    2015-01-01

    Objective: In this case study, biomechanical alterations induced by neuromuscular taping (NMT) were quantified, during walking, in a patient with joint hypermobility syndrome/Ehlers–Danlos syndrome hypermobility type (JHS/EDS-HT). Methods: A female JHS/EDS-HT patient underwent NMT applications over the low back spine and bilaterally to the knee. Quantitative gait analyses were collected before the NMT application and at the end of the treatment (2 weeks after the first application of NMT). Results: At the end of treatment following the NMT application, left step length showed improvements in cadence and velocity, the left knee showed a reduction in its flexed position at initial contact, and the right ankle joint improved its position at initial contact and in the swing phase. Improvements were also found in kinetics, in terms of the ankle moment and power. Conclusions: Results show that NMT seems to be a promising low-cost intervention for improving gait strategy in patients with JHS/EDS-HT. Further investigations are needed to assess the effects of this treatment intervention on pathological symptoms. PMID:25649985

  7. The effects of neuromuscular taping on gait walking strategy in a patient with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type.

    Science.gov (United States)

    Camerota, Filippo; Galli, Manuela; Cimolin, Veronica; Celletti, Claudia; Ancillao, Andrea; Blow, David; Albertini, Giorgio

    2015-02-01

    In this case study, biomechanical alterations induced by neuromuscular taping (NMT) were quantified, during walking, in a patient with joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT). A female JHS/EDS-HT patient underwent NMT applications over the low back spine and bilaterally to the knee. Quantitative gait analyses were collected before the NMT application and at the end of the treatment (2 weeks after the first application of NMT). At the end of treatment following the NMT application, left step length showed improvements in cadence and velocity, the left knee showed a reduction in its flexed position at initial contact, and the right ankle joint improved its position at initial contact and in the swing phase. Improvements were also found in kinetics, in terms of the ankle moment and power. Results show that NMT seems to be a promising low-cost intervention for improving gait strategy in patients with JHS/EDS-HT. Further investigations are needed to assess the effects of this treatment intervention on pathological symptoms.

  8. Strategies to Advance Drug Discovery in Rare Monogenic Intellectual Disability Syndromes

    Science.gov (United States)

    Hettige, Nuwan C; Manzano-Vargas, Karla; Jefri, Malvin; Ernst, Carl

    2018-01-01

    Abstract Some intellectual disability syndromes are caused by a mutation in a single gene and have been the focus of therapeutic intervention attempts, such as Fragile X and Rett Syndrome, albeit with limited success. The rate at which new drugs are discovered and tested in humans for intellectual disability is progressing at a relatively slow pace. This is particularly true for rare diseases where so few patients make high-quality clinical trials challenging. We discuss how new advances in human stem cell reprogramming and gene editing can facilitate preclinical study design and we propose new workflows for how the preclinical to clinical trajectory might proceed given the small number of subjects available in rare monogenic intellectual disability syndromes. PMID:29040584

  9. Diagnosis and prevention of overtraining syndrome: an opinion on education strategies

    Directory of Open Access Journals (Sweden)

    Kreher JB

    2016-09-01

    Full Text Available Jeffrey B Kreher Department of Orthopaedics, Division of Pediatric Orthopaedics, Massachusetts General Hospital and Massachusetts General Hospital for Children, Boston, MA, USA Abstract: Overtraining syndrome is a condition of maladapted physiology in the setting of excessive exercise without adequate rest. The exact etiology and pathogenesis are unknown and being investigated. Symptoms are multisystem in nature and often representative of underlying hormonal, immunologic, neurologic, and psychologic disturbances. Unfortunately, systematic review of the literature does not clearly direct diagnosis, management, or prevention. However, given the severity of symptoms and impairment to quality of life, prevention of overtraining syndrome should be considered by all who interact with endurance athletes. This article will provide suggestions for management of at-risk athletes despite absence of validated diagnostic tests and preventative measures. Keywords: overreaching, unexplained underperformance, burnout, muscle failure syndrome

  10. Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.

    Science.gov (United States)

    Russo, Ethan B

    2016-01-01

    Medicine continues to struggle in its approaches to numerous common subjective pain syndromes that lack objective signs and remain treatment resistant. Foremost among these are migraine, fibromyalgia, and irritable bowel syndrome, disorders that may overlap in their affected populations and whose sufferers have all endured the stigma of a psychosomatic label, as well as the failure of endless pharmacotherapeutic interventions with substandard benefit. The commonality in symptomatology in these conditions displaying hyperalgesia and central sensitization with possible common underlying pathophysiology suggests that a clinical endocannabinoid deficiency might characterize their origin. Its base hypothesis is that all humans have an underlying endocannabinoid tone that is a reflection of levels of the endocannabinoids, anandamide (arachidonylethanolamide), and 2-arachidonoylglycerol, their production, metabolism, and the relative abundance and state of cannabinoid receptors. Its theory is that in certain conditions, whether congenital or acquired, endocannabinoid tone becomes deficient and productive of pathophysiological syndromes. When first proposed in 2001 and subsequently, this theory was based on genetic overlap and comorbidity, patterns of symptomatology that could be mediated by the endocannabinoid system (ECS), and the fact that exogenous cannabinoid treatment frequently provided symptomatic benefit. However, objective proof and formal clinical trial data were lacking. Currently, however, statistically significant differences in cerebrospinal fluid anandamide levels have been documented in migraineurs, and advanced imaging studies have demonstrated ECS hypofunction in post-traumatic stress disorder. Additional studies have provided a firmer foundation for the theory, while clinical data have also produced evidence for decreased pain, improved sleep, and other benefits to cannabinoid treatment and adjunctive lifestyle approaches affecting the ECS.

  11. A model-based assessment of the cost–utility of strategies to identify Lynch syndrome in early-onset colorectal cancer patients

    International Nuclear Information System (INIS)

    Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

    2015-01-01

    Lynch syndrome is an autosomal dominant cancer predisposition syndrome caused by mutations in the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2. Individuals with Lynch syndrome have an increased risk of colorectal cancer, endometrial cancer, ovarian and other cancers. Lynch syndrome remains underdiagnosed in the UK. Reflex testing for Lynch syndrome in early-onset colorectal cancer patients is proposed as a method to identify more families affected by Lynch syndrome and offer surveillance to reduce cancer risks, although cost-effectiveness is viewed as a barrier to implementation. The objective of this project was to estimate the cost–utility of strategies to identify Lynch syndrome in individuals with early-onset colorectal cancer in the NHS. A decision analytic model was developed which simulated diagnostic and long-term outcomes over a lifetime horizon for colorectal cancer patients with and without Lynch syndrome and for relatives of those patients. Nine diagnostic strategies were modelled which included microsatellite instability (MSI) testing, immunohistochemistry (IHC), BRAF mutation testing (methylation testing in a scenario analysis), diagnostic mutation testing and Amsterdam II criteria. Biennial colonoscopic surveillance was included for individuals diagnosed with Lynch syndrome and accepting surveillance. Prophylactic hysterectomy with bilateral salpingo-oophorectomy (H-BSO) was similarly included for women diagnosed with Lynch syndrome. Costs from NHS and Personal Social Services perspective and quality-adjusted life years (QALYs) were estimated and discounted at 3.5% per annum. All strategies included for the identification of Lynch syndrome were cost-effective versus no testing. The strategy with the greatest net health benefit was MSI followed by BRAF followed by diagnostic genetic testing, costing £5,491 per QALY gained over no testing. The effect of prophylactic H-BSO on health-related quality of life (HRQoL) is uncertain and could

  12. A model-based assessment of the cost-utility of strategies to identify Lynch syndrome in early-onset colorectal cancer patients.

    Science.gov (United States)

    Snowsill, Tristan; Huxley, Nicola; Hoyle, Martin; Jones-Hughes, Tracey; Coelho, Helen; Cooper, Chris; Frayling, Ian; Hyde, Chris

    2015-04-25

    Lynch syndrome is an autosomal dominant cancer predisposition syndrome caused by mutations in the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2. Individuals with Lynch syndrome have an increased risk of colorectal cancer, endometrial cancer, ovarian and other cancers. Lynch syndrome remains underdiagnosed in the UK. Reflex testing for Lynch syndrome in early-onset colorectal cancer patients is proposed as a method to identify more families affected by Lynch syndrome and offer surveillance to reduce cancer risks, although cost-effectiveness is viewed as a barrier to implementation. The objective of this project was to estimate the cost-utility of strategies to identify Lynch syndrome in individuals with early-onset colorectal cancer in the NHS. A decision analytic model was developed which simulated diagnostic and long-term outcomes over a lifetime horizon for colorectal cancer patients with and without Lynch syndrome and for relatives of those patients. Nine diagnostic strategies were modelled which included microsatellite instability (MSI) testing, immunohistochemistry (IHC), BRAF mutation testing (methylation testing in a scenario analysis), diagnostic mutation testing and Amsterdam II criteria. Biennial colonoscopic surveillance was included for individuals diagnosed with Lynch syndrome and accepting surveillance. Prophylactic hysterectomy with bilateral salpingo-oophorectomy (H-BSO) was similarly included for women diagnosed with Lynch syndrome. Costs from NHS and Personal Social Services perspective and quality-adjusted life years (QALYs) were estimated and discounted at 3.5% per annum. All strategies included for the identification of Lynch syndrome were cost-effective versus no testing. The strategy with the greatest net health benefit was MSI followed by BRAF followed by diagnostic genetic testing, costing £5,491 per QALY gained over no testing. The effect of prophylactic H-BSO on health-related quality of life (HRQoL) is uncertain and could outweigh

  13. Imaging biomarkers in Parkinson's disease and Parkinsonian syndromes: current and emerging concepts.

    Science.gov (United States)

    Saeed, Usman; Compagnone, Jordana; Aviv, Richard I; Strafella, Antonio P; Black, Sandra E; Lang, Anthony E; Masellis, Mario

    2017-01-01

    Two centuries ago in 1817, James Parkinson provided the first medical description of Parkinson's disease, later refined by Jean-Martin Charcot in the mid-to-late 19th century to include the atypical parkinsonian variants (also termed, Parkinson-plus syndromes). Today, Parkinson's disease represents the second most common neurodegenerative disorder with an estimated global prevalence of over 10 million. Conversely, atypical parkinsonian syndromes encompass a group of relatively heterogeneous disorders that may share some clinical features with Parkinson's disease, but are uncommon distinct clinicopathological diseases. Decades of scientific advancements have vastly improved our understanding of these disorders, including improvements in in vivo imaging for biomarker identification. Multimodal imaging for the visualization of structural and functional brain changes is especially important, as it allows a 'window' into the underlying pathophysiological abnormalities. In this article, we first present an overview of the cardinal clinical and neuropathological features of, 1) synucleinopathies: Parkinson's disease and other Lewy body spectrum disorders, as well as multiple system atrophy, and 2) tauopathies: progressive supranuclear palsy, and corticobasal degeneration. A comprehensive presentation of well-established and emerging imaging biomarkers for each disorder are then discussed. Biomarkers for the following imaging modalities are reviewed: 1) structural magnetic resonance imaging (MRI) using T1, T2, and susceptibility-weighted sequences for volumetric and voxel-based morphometric analyses, as well as MRI derived visual signatures, 2) diffusion tensor MRI for the assessment of white matter tract injury and microstructural integrity, 3) proton magnetic resonance spectroscopy for quantifying proton-containing brain metabolites, 4) single photon emission computed tomography for the evaluation of nigrostriatal integrity (as assessed by presynaptic dopamine

  14. Cancer-related anorexia/cachexia syndrome and oxidative stress: an innovative approach beyond current treatment.

    Science.gov (United States)

    Mantovani, Giovanni; Madeddu, Clelia; Macciò, Antonio; Gramignano, Giulia; Lusso, Maria Rita; Massa, Elena; Astara, Giorgio; Serpe, Roberto

    2004-10-01

    Cancer-related anorexia/cachexia syndrome and oxidative stress play a key role in the progression and outcome of neoplastic disease. On the basis of our previously published studies and clinical experience, we have developed an innovative approach consisting of diet with high polyphenol content (400 mg), p.o. pharmaconutritional support enriched with n - 3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid) 2 cans (237 mL each) per day, medroxiprogesterone acetate 500 mg/d, antioxidant treatment with alpha-lipoic acid 300 mg/d plus carbocysteine lysine salt 2.7 g/d plus vitamin E 400 mg/d plus vitamin A 30,000 IU/d plus vitamin C 500 mg/d, and selective cyclooxygenase-2 inhibitor Celecoxib 200 mg/d. The treatment is administered for 16 weeks. The following variables are evaluated: (a) clinical variables (stage and Eastern Cooperative Oncology Group performance status); (b) nutritional variables (lean body mass, appetite, and resting energy expenditure); (c) laboratory variables (serum levels of proinflammatory cytokines, C-reactive protein, and leptin and blood levels of reactive oxygen species and antioxidant enzymes); and (d) quality of life variables (European Organization for Research and Treatment of Cancer QLQ-C30, EQ-5Dindex, and EQ-5DVAS). A phase II nonrandomized study has been designed to enroll 40 patients with advanced cancer at different sites with symptoms of cancer-related anorexia/cachexia syndrome and oxidative stress. As of January 2004, 28 patients have been enrolled: 25 patients were evaluable and 14 of them have completed the treatment (20 patients have completed 2 months of treatment). As for clinical response, five patients improved, three patients remained unchanged, and six patients worsened. The Eastern Cooperative Oncology Group performance status (grade) 1 remained unchanged. As for nutritional/functional variables, the lean body mass increased significantly at 2 and 4 months. As for laboratory variables, reactive oxygen species

  15. Novel Differential Current Control Strategy Based on a Modified Three-Level SVPWM for Two Parallel-Connected Inverters

    DEFF Research Database (Denmark)

    Zorig, Abdelmalik; Barkat, Said; Belkheiri, Mohammed

    2017-01-01

    Recently, parallel inverters have been investigated to provide multilevel characteristics besides their advantage to increase the power system capacity, reliability, and efficiency. However, the issue of differential currents imbalance remains a challenge in parallel inverter operation. The distr......Recently, parallel inverters have been investigated to provide multilevel characteristics besides their advantage to increase the power system capacity, reliability, and efficiency. However, the issue of differential currents imbalance remains a challenge in parallel inverter operation....... The distribution of switching vectors of the resulting multilevel topology has a certain degree of self-differential current balancing properties. Nevertheless, the method alone is not sufficient to maintain balanced differential current in practical applications. This paper proposes a closed-loop differential...... current control method by introducing a control variable adjusting the dwell time of the selected switching vectors and thus maintaining the differential currents balanced without affecting the overall system performance. The control strategy, including distribution of switching sequence, selection...

  16. Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis

    NARCIS (Netherlands)

    Bleker, S. M.; van Es, N.; Kleinjan, A.; Buller, H. R.; Kamphuisen, P. W.; Aggarwal, A.; Beyer-Westendorf, J.; Camporese, G.; Cosmi, B.; Gary, T.; Ghirarduzzi, A.; Kaasjager, K.; Lerede, T.; Marschang, P.; Meijer, Karina; Otten, H. -M.; Porreca, E.; Righini, M.; Verhamme, P.; van Wissen, S.; Di Nisio, M.

    Background: There is scant information on the optimal management and clinical outcome of deep and superficial vein thrombosis of the upper extremity (UEDVT and UESVT). Objectives: To explore treatment strategies and the incidence of recurrent venous thromboembolism (VTE), mortality, postthrombotic

  17. Late-life suicide prevention strategies: current status and future directions.

    Science.gov (United States)

    Van Orden, Kim; Deming, Charlene

    2017-09-08

    Late life suicide prevention differs from suicide prevention for other age groups: first, the number of older adults worldwide is on the rise; second, late-life suicide receives much less attention in all societal spheres, from the media, to federal funding agencies, to healthcare initiatives. Recent findings indicate an association between internalized ageist stereotypes and reduced will to live. Recent research also addresses the role of cognitive control as a contributor to risk and as an intervention target (e.g., through psychotherapies such as problem solving therapy) as well as firearm safety as a promising, though a politicized and challenging strategy to implement. Another strategy that may prove feasible is an approach on upstream prevention strategies in healthcare. One strategy we believe holds great promise is the promotion of high quality geriatric medicine. Geriatricians are trained to work with patients to prioritize the promotion of physical and cognitive functioning (rather than solely absence of disease) and to focus on well-being as a goal. Thus, geriatricians routinely target numerous late-life suicide risk factors-physical illness, functioning, pain, and (dis)satisfaction with life. However, efficacious strategies will not prevent suicide deaths if they are not implemented-addressing ageism as a universal prevention strategy is essential. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Current State of the Art: Management of Higher Risk Myelodysplastic Syndromes.

    Science.gov (United States)

    Komrokji, Rami S

    2016-08-01

    The higher risk myelodysplastic syndrome (MDS) patients, defined by the International Prognostic Scoring System (IPSS) as intermediate-2 or high-risk groups, compromise a third of MDS patients who have an expected survival of less than 1.5 years. Our ability to better define higher risk MDS improved with the proposal of new clinical risk models such as the revised IPSS and by integration of molecular data, including somatic gene mutations. Allogeneic hematopoietic stem-cell transplantation (AHSCT) remains the only curative option. In higher risk MDS patients, proceeding early with AHSCT is associated with maximum survival gain. The decision to pursue AHSCT is individualized according to disease risk, comorbidities, and functional status. The role of therapy before AHSCT remains controversial, and the role of post-AHSCT maintenance is evolving. Hypomethylating agents are the only medications that alter the natural history of the disease. Azacitidine is the only drug reported to improve overall survival in higher risk MDS patients. Appropriate use and assessment of response is key for assuring patients benefit of such limited options. Treatment after failure of hypomethylating agents is an unmet need. The role of detectable somatic gene mutations in prognosis and tailoring therapy continue to emerge. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Cognitive-behavioral therapy for patients with irritable bowel syndrome: current insights.

    Science.gov (United States)

    Kinsinger, Sarah W

    2017-01-01

    Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) condition associated with significant health care utilization and quality-of-life impairment. Latest research indicates that the brain-gut axis plays a key role in the disorder, and the presence of psychological factors and central processing deficits contribute to symptom severity and disability. Psychological therapies as a whole have demonstrated good efficacy in reducing the severity of IBS symptoms. Cognitive-behavioral therapy (CBT) has been tested most rigorously in multiple randomized controlled trials and consistently demonstrates significant and durable effects on IBS symptoms and quality of life. Various protocols for treating IBS have been developed, and most recent advances in the field include exposure-based treatments to target symptom-specific anxiety as well as modified delivery methods, including internet-based treatment models. Despite the well-documented advantages of CBT for IBS, it has been poorly disseminated and few patients have access to this treatment. The primary barrier to dissemination is the limited number of therapists with adequate training in GI psychology to provide this evidence-based intervention. Future developments in the field need to focus on training opportunities to equip more therapists to competently provide CBT for this population. Further efforts to develop telemedicine platforms for delivering this intervention will also improve accessibility for patients.

  20. Current diagnosis and treatment of cryptococcal meningitis without acquired immunodeifciency syndrome

    Institute of Scientific and Technical Information of China (English)

    Xiao-Su Guo; Ze-Yan Zhao; Hui Bu; Jun-Ying He; Yue-Li Zou; Yue Zhao; Yuan-Yuan Li; Jun-Zhao Cui; Ming-Ming Zheng; Wei-Xin Han

    2016-01-01

    Cryptococcal meningitis (CM) is a central nervous system infectious disease caused by Cryptococcus. It is the most common fungal infection in the central nervous system, accounting for about 48% of fungal infection. The disease occurs mainly in acquired immunodeifciency syndrome (AIDS) patients and concentrates in the immunocompromised people without AIDS. There are nearly one million new cases of CM each year, and about 70% of them died. In China, CM occurs mainly in people without AIDS and there is an increasing trend in recent years. Early diagnosis and treatment is the key to reducing morbidity and mortality associated with CM. The diagnosis mainly depends on laboratory examination such as morphological examination, fungal culture and antigen detection. History, clinical manifestation and imaging examination are the important parts of auxiliary examination. The initial combined antifungal treatment is emphasized, and the principle of fractional treatment including induction, consolidation and maintenance therapy should be followed. The high intracranial pressure must be reduced actively at the same time. In addition, it is proved that the novel immunotherapy combined with antifungal agents can improve the curative effect and limit the chance of antimicrobial resistance. Large-scale clinical trials are needed for further study.

  1. Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

    Directory of Open Access Journals (Sweden)

    Dejan V. Radenkovic

    2016-01-01

    Full Text Available Abdominal compartment syndrome (ACS in patients with severe acute pancreatitis (SAP is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

  2. Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective.

    Science.gov (United States)

    Radenkovic, Dejan V; Johnson, Colin D; Milic, Natasa; Gregoric, Pavle; Ivancevic, Nenad; Bezmarevic, Mihailo; Bilanovic, Dragoljub; Cijan, Vladimir; Antic, Andrija; Bajec, Djordje

    2016-01-01

    Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

  3. The Stressors and Coping Strategies of Older Adults With Persistent Atrial Fibrillation Prior to and Following Direct Current Cardioversion.

    Science.gov (United States)

    Rush, Kathy L; Hatt, Linda; Shay, Matt; Gorman, Nicole; Laberge, Carol G; Reid, R Colin; Wilson, Ryan

    2017-09-01

    The purpose of this study was to explore the stressors and coping strategies of older adults with persistent atrial fibrillation (AF) before and after direct current cardioversion. The study used a qualitative descriptive design. Sixteen patients were recruited through an AF clinic to participate in individual interviews prior to the cardioversion and at 6 and 12 weeks post procedure. Pre-cardioversion, older adults experienced symptom and health care-related stressors superimposed on existing non-AF stressors. They used a range of emotion and problem-focused coping. Non-AF stressors increased post procedure at the same time that participants perceived less need for coping strategies with a return to regular rhythm. There was a shift from AF to non-AF related stressors following the cardioversion but a decrease in coping strategies. Older adults with AF should be encouraged to maintain use of coping strategies to manage ongoing stress and reduce the risk of AF recurrence.

  4. Using Visual Strategies to Support Verbal Comprehension in an Adolescent with Down Syndrome

    Science.gov (United States)

    Lecas, Jean-Francois; Mazaud, Anne-Marie; Reibel, Esther; Rey, Arnaud

    2011-01-01

    It has been frequently reported that children with Down syndrome have deficits in verbal short-term memory while having relatively good performance in visual short-term memory tasks. Such verbal deficits have a detrimental effect on various high-level cognitive processes, most notably language comprehension. In this study, we report the case of an…

  5. Comparison of Visual-Spatial Performance Strategy Training in Children with Turner Syndrome and Learning Disabilities.

    Science.gov (United States)

    Williams, Janet K.; And Others

    1992-01-01

    Thirteen females with Turner syndrome, 13 females with nonverbal learning disabilities, and 14 males with nonverbal learning disabilities, ages 7-14, were taught via a cognitive behavioral modification approach to verbally mediate a spatial matching task. All three groups showed significant task improvement after the training, with no significant…

  6. Pathophysiologic Domains Underlying the Metabolic Syndrome: An Alternative Factor Analytic Strategy

    NARCIS (Netherlands)

    Peeters, C. F. W.; Dziura, J.; van Wesel, F.; Peeters, C.F.W.

    2014-01-01

    Factor analysis (FA) has become part and parcel in metabolic syndrome (MBS) research. Both exploration- and confirmation-driven factor analyzes are rampant. However, factor analytic results on MBS differ widely. A situation that is at least in part attributable to misapplication of FA. Here, our

  7. Pulse Pattern-Modulated Strategy for Harmonic Current Components Reduction in Three-Phase AC–DC Converters

    DEFF Research Database (Denmark)

    Davari, Pooya; Zare, Firuz; Blaabjerg, Frede

    2016-01-01

    , which need to be considered in order to be competitive in the market. Therefore, having a flexibility to meet various requirements imposed by the standard recommendations or costumer needs is at most desirable. This makes the generated harmonic current mitigation a challenging task especially with three......-phase diode bridge rectifier, which still is preferred in many power electronic systems. This paper addresses a novel current modulation strategy using a single-switch boost three-phase diode bridge rectifier. The proposed method can selectively mitigate current harmonics, which makes it suitable...

  8. Pulse pattern modulated strategy for harmonic current components reduction in three-phase AC-DC converters

    DEFF Research Database (Denmark)

    Davari, Pooya; Zare, Firuz; Blaabjerg, Frede

    2015-01-01

    , which need to be considered in order to be competitive in the market. Therefore, having a flexibility to meet various requirements imposed by the standard recommendations or costumer needs is at most desirable. This makes the generated harmonic current mitigation a challenging task especially with three......-phase diode bridge rectifier, which still is preferred in many power electronic systems. This paper addresses a novel current modulation strategy using a single-switch boost three-phase diode bridge rectifier. The proposed method can selectively mitigate current harmonics, which makes it suitable...

  9. The effect of problem-focused coping strategy training on psychological symptoms of mothers of children with down syndrome.

    Science.gov (United States)

    Pourmohamadreza-Tajrishi, Masoume; Azadfallah, Parviz; Hemmati Garakani, Sahel; Bakhshi, Enayatollah

    2015-02-01

    Anxiety is one of the most common reactions that parents show while understanding their children's intellectual disability due to Down syndrome. Anxiety leads parents not to develop appropriate relations with their children, subsequently their psychological health are at risk. The present study was aimed to determine the effect of problem-focused coping strategy training on psychological symptoms of mothers with Down child. This was an experimental study with pretest and posttest design with case and control group. Sixty-four mothers were selected randomly from Iranian Down Syndrome Charity Society. They completed Symptoms Checklist-90-Revised (SCL-90-R). They were assigned to experimental and control groups in equal. Experimental group participated in 12 training sessions (once a week; 60 minutes for each session) and received problem-focused coping strategy program, but control group did not. After 12(th) session, all subjects completed SCL-90-R again. Analysis of covariance was used for analyzing the data. There was a significant difference (Pstrategy-training program led to improve family's perception towards the child and subsequently promote of mental health of mothers with Down children.

  10. Gait Strategy in Patients with Ehlers-Danlos Syndrome Hypermobility Type: A Kinematic and Kinetic Evaluation Using 3D Gait Analysis

    Science.gov (United States)

    Galli, Manuela; Cimolin, Veronica; Rigoldi, Chiara; Castori, Marco; Celletti, Claudia; Albertini, Giorgio; Camerota, Filippo

    2011-01-01

    The aim of this study was to quantify the gait patterns of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome (JHS/EDS-HT) hypermobility type, using Gait Analysis. We quantified the gait strategy in 12 JHS/EDS-HT adults individuals (age: 43.08 + 6.78 years) compared to 20 healthy controls (age: 37.23 plus or minus 8.91 years), in…

  11. Incorporating DNA sequencing into current prenatal screening practice for Down's syndrome.

    Directory of Open Access Journals (Sweden)

    Nicholas J Wald

    Full Text Available BACKGROUND: Prenatal screening for Down's syndrome is performed using biochemical and ultrasound markers measured in early pregnancy such as the Integrated test using first and second trimester markers. Recently, DNA sequencing methods have been introduced on free DNA in maternal plasma, yielding a high screening performance. These methods are expensive and there is a test failure rate. We determined the screening performance of merging the Integrated test with the newer DNA techniques in a protocol that substantially reduces the cost compared with universal DNA testing and still achieves high screening performance with no test failures. METHODS: Published data were used to model screening performance of a protocol in which all women receive the first stage of the Integrated test at about 11 weeks of pregnancy. On the basis of this higher risk women have reflex DNA testing and lower risk women as well as those with a failed DNA test complete the Integrated test at about 15 weeks. RESULTS: The overall detection rate was 95% with a 0.1% false-positive rate if 20% of women were selected to receive DNA testing. If all women had DNA testing the detection rate would be 3 to 4 percentage points higher with a false-positive rate 30 times greater if women with failed tests were treated as positive and offered a diagnostic amniocentesis, or 3 times greater if they had a second trimester screening test (Quadruple test and treated as positive only if this were positive. The cost per women screened would be about one-fifth, compared with universal DNA testing, if the DNA test were 20 times the cost of the Integrated test. CONCLUSION: The proposed screening protocol achieves a high screening performance without programme test failures and at a substantially lower cost than offering all women DNA testing.

  12. Adolescence and polycystic ovary syndrome: current concepts on diagnosis and treatment.

    Science.gov (United States)

    Spritzer, P M; Motta, A B

    2015-11-01

    Adolescence is a time characterised by changes in reproductive hormones and menstrual patterns, which makes it difficult to diagnose polycystic ovary syndrome (PCOS) in this population. The diagnosis of PCOS has a great physical and psychosocial impact on the young person. Despite the importance of a diagnosis of PCOS at adolescence, data available are limited. This review focuses on analysing markers of PCOS diagnosis and possible treatments in adolescence. Although, during adolescence, diagnosis criteria of PCOS overlap with physiological changes including clinical manifestations of hyperandrogenism (acne and hirsutism), oligo/amenorrhoea, anovulation and ovarian microcysts, there is agreement that irregular menses and hyperandrogenaemia should be used to diagnose PCOS in this population. Moreover, considering that PCOS phenotype could change through the reproductive age and that adolescents display heterogeneous ovarian morphology, it has been proposed that diagnosis of PCOS should be confirmed after the age of 18. The first-line treatment for menstrual irregularity and hirsutism are oral contraceptive pills (OCPs) and for obesity and metabolic abnormalities are lifestyle changes. Insulin-sensitizer drugs, such as metformin, may be added to the treatment in the presence of metabolic alterations. Antiandrogen drugs may also be associated for treating moderate to severe hirsutism. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include lifestyle changes. Pharmacological treatments comprise OCPs, antiandrogens and metformin, used isolated or combined. During adolescence, physiological changes overlap with signs and symptoms of PCOS; thus the diagnosis criteria should be carefully considered. Regarding the treatment of adolescents with PCOS, non-pharmacological interventions include

  13. γ-Tocotrienol as a Promising Countermeasure for Acute Radiation Syndrome: Current Status

    Directory of Open Access Journals (Sweden)

    Vijay K. Singh

    2016-05-01

    Full Text Available The hazard of ionizing radiation exposure due to nuclear accidents or terrorist attacks is ever increasing. Despite decades of research, still, there is a shortage of non-toxic, safe and effective medical countermeasures for radiological and nuclear emergency. To date, the U.S. Food and Drug Administration (U.S. FDA has approved only two growth factors, Neupogen (granulocyte colony-stimulating factor (G-CSF, filgrastim and Neulasta (PEGylated G-CSF, pegfilgrastim for the treatment of hematopoietic acute radiation syndrome (H-ARS following the Animal Efficacy Rule. Promising radioprotective efficacy results of γ-tocotrienol (GT3; a member of the vitamin E family in the mouse model encouraged its further evaluation in the nonhuman primate (NHP model. These studies demonstrated that GT3 significantly aided the recovery of radiation-induced neutropenia and thrombocytopenia compared to the vehicle controls; these results particularly significant after exposure to 5.8 or 6.5 Gray (Gy whole body γ-irradiation. The stimulatory effect of GT3 on neutrophils and thrombocytes (platelets was directly and positively correlated with dose; a 75 mg/kg dose was more effective compared to 37.5 mg/kg. GT3 was also effective against 6.5 Gy whole body γ-irradiation for improving neutrophils and thrombocytes. Moreover, a single administration of GT3 without any supportive care was equivalent, in terms of improving hematopoietic recovery, to multiple doses of Neupogen and two doses of Neulasta with full supportive care (including blood products in the NHP model. GT3 may serve as an ultimate radioprotector for use in humans, particularly for military personnel and first responders. In brief, GT3 is a promising radiation countermeasure that ought to be further developed for U.S. FDA approval for the ARS indication.

  14. Chronic Fatigue Syndrome and Women: Can Therapy Help?

    Science.gov (United States)

    Burke, Susan G.

    1992-01-01

    Presents current research on chronic fatigue syndrome, which currently afflicts mostly females between ages of 25 and 55. Notes that, because depression is common symptom of chronic fatigue syndrome, mental health practitioners are often involved with victims and must formulate appropriate treatment strategy that considers physiological,…

  15. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    Science.gov (United States)

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  16. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments.

    Science.gov (United States)

    Franklyn, Melanie; Oakes, Barry

    2015-09-18

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  17. New strategy for eliminating zero-sequence circulating current between parallel operating three-level NPC voltage source inverters

    DEFF Research Database (Denmark)

    Li, Kai; Dong, Zhenhua; Wang, Xiaodong

    2018-01-01

    A novel strategy based on a zero common mode voltage pulse-width modulation (ZCMV-PWM) technique and zero-sequence circulating current (ZSCC) feedback control is proposed in this study to eliminate ZSCCs between three-level neutral point clamped (NPC) voltage source inverters, with common AC and DC......, the ZCMV-PWM method is presented to reduce CMVs, and a simple electric circuit is adopted to control ZSCCs and neutral point potential. Finally, simulation and experiment are conducted to illustrate effectiveness of the proposed strategy. Results show that ZSCCs between paralleled inverters can...

  18. Instantaneous Project Controls: Current Status, State of the Art, Benefits, and Strategies

    Science.gov (United States)

    Abbaszadegan, Amin

    2016-01-01

    Despite advancements in construction and construction-related technology, capital project performance deviations, typically overruns, remain endemic within the capital projects industry. Currently, management is generally unaware of the current status of their projects, and thus monitoring and control of projects are not achieved effectively. In…

  19. Novel pharmacotherapeutic strategies for treatment of opioid-induced neonatal abstinence syndrome

    OpenAIRE

    McLemore, Gabrielle L.; Lewis, Tamorah; Jones, Catherine H.; Gauda, Estelle B.

    2012-01-01

    The non-medical use of prescription drugs, in general, and opioids, in particular, is a national epidemic, resulting in enormous addiction rates, healthcare expenditures, and overdose deaths. Prescription opioids are overly prescribed, illegally trafficked, and frequently abused, all of which have created a new opioid addiction pathway, adding to the number of opioid-dependent newborns requiring treatment for neonatal abstinence syndrome (NAS), and contributing to challenges in effective care...

  20. Biological strategies for enhanced hydrolysis of lignocellulosic biomass during anaerobic digestion: Current status and future perspectives.

    Science.gov (United States)

    Shrestha, Shilva; Fonoll, Xavier; Khanal, Samir Kumar; Raskin, Lutgarde

    2017-12-01

    Lignocellulosic biomass is the most abundant renewable bioresource on earth. In lignocellulosic biomass, the cellulose and hemicellulose are bound with lignin and other molecules to form a complex structure not easily accessible to microbial degradation. Anaerobic digestion (AD) of lignocellulosic biomass with a focus on improving hydrolysis, the rate limiting step in AD of lignocellulosic feedstocks, has received considerable attention. This review highlights challenges with AD of lignocellulosic biomass, factors contributing to its recalcitrance, and natural microbial ecosystems, such as the gastrointestinal tracts of herbivorous animals, capable of performing hydrolysis efficiently. Biological strategies that have been evaluated to enhance hydrolysis of lignocellulosic biomass include biological pretreatment, co-digestion, and inoculum selection. Strategies to further improve these approaches along with future research directions are outlined with a focus on linking studies of microbial communities involved in hydrolysis of lignocellulosics to process engineering. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Computational Fragment-Based Drug Design: Current Trends, Strategies, and Applications.

    Science.gov (United States)

    Bian, Yuemin; Xie, Xiang-Qun Sean

    2018-04-09

    Fragment-based drug design (FBDD) has become an effective methodology for drug development for decades. Successful applications of this strategy brought both opportunities and challenges to the field of Pharmaceutical Science. Recent progress in the computational fragment-based drug design provide an additional approach for future research in a time- and labor-efficient manner. Combining multiple in silico methodologies, computational FBDD possesses flexibilities on fragment library selection, protein model generation, and fragments/compounds docking mode prediction. These characteristics provide computational FBDD superiority in designing novel and potential compounds for a certain target. The purpose of this review is to discuss the latest advances, ranging from commonly used strategies to novel concepts and technologies in computational fragment-based drug design. Particularly, in this review, specifications and advantages are compared between experimental and computational FBDD, and additionally, limitations and future prospective are discussed and emphasized.

  2. A review of current strategies to reduce intraoperative bacterial contamination of surgical wounds

    OpenAIRE

    Dohmen, Pascal M.; Konertz, Wolfgang

    2007-01-01

    Surgical site infections are a mean topic in cardiac surgery, leading to a prolonged hospitalization, and substantially increased morbidity and mortality. One source of pathogens is the endogenous flora of the patient?s skin, which can contaminate the surgical site. A number of preoperative skin care strategies are performed to reduce bacterial contamination like preoperative antiseptic showering, hair removal, antisepsis of the skin, adhesive barrier drapes, and antimicrobial prophylaxis. Fu...

  3. [Current topics on cancer biology and research strategies for anti-cancer traditional Chinese medicine].

    Science.gov (United States)

    Chen, Xiu-ping; Tang, Zheng-hai; Shi, Zhe; Lu, Jin-jian; Su, Huan-xing; Chen, Xin; Wang, Yi-tao

    2015-09-01

    Cancer, an abnormal cell proliferation resulted from multi-factors,has the highest morbidity and mortality among all the serious diseases. Considerable progress has been made in cancer biology in recent years. Tumor immunology, cancer stem cells (CSCs), autophagy, and epithelial-mesenchymal transition (EMT) have become hot topics of interests in this area. Detailed dissection of these biological processes will provide novel directions, targets, and strategies for the pharmacological evaluation, mechanism elucidation, and new drug development of traditional Chinese medicine.

  4. CURRENT DEVELOPMENT STRATEGIES FOR VACCINES AND THE ROLE OF REVERSE VACCINOLOGY

    OpenAIRE

    RAJU.S , UMA MAHESHWARA RAO.V

    2013-01-01

    The concept of vaccination has been around forcenturies .Vaccines constitutes cost-effective measures forpreventing disease. Advances in biotechnology and anunderstanding of the inductive and effector components ofimmune responses have ushered in a „golden age‟ ofvaccine development and implementation. Many licensedvaccines have one or more ideal characteristics, but nonemanifests them all. Of the generic vaccine technologies andvaccination strategies in different stages of development,some h...

  5. Current status of decommissioning projects and their strategies in advanced countries

    International Nuclear Information System (INIS)

    Chung, U. S.; Lee, K. W.; Hwang, D. S.; Park, S. K.; Hwang, S. T.; Paik, S. T.; Park, J. H.; Choi, Y. D.; Chung, K. H.; Lee, K. I.; Hong, S. B.

    2007-06-01

    At the Korea Atomic Energy Research Institute(KAERI), two projects for decommissioning of the research reactors and uranium conversion plant are carried out. The number of nuclear facilities to be dismantled will be much increased in future and the decommissioning industries will be enlarged. Keeping pace with this increasing tendency, each country formulated their own strategies and regulation systems, and applied their own technologies. The international organizations such as the IAEA and the OECD/NEA also prepared standards in technologies and regulation upon decommissioning and recommended to adopt them to the decommissioning projects. These strategies and technologies are very different country by country due to the different site dependent conditions and it will not be reasonable to evaluate their merits and weakness. The world wide status of the decommissioning, highlighted on that of 5 countries of USA, UK, France, Germany and Japan because they are advanced counties in nuclear industries, are summarized and their site specific conditions are evaluated. The scopes of the evaluation are decommissioning strategies, licensing procedures and requirements focused on decommissioning plan, waste management, technology development and so on. The detailed decommissioning progresses of several typical example sites were introduced. The activities on decommissioning field of the international organization, increased according to the enlarged decommissioning industries, are also summarized

  6. Bigger, Brighter, Bluer-Better?Current light-emitting devices- adverse sleep properties and preventative strategies.

    Directory of Open Access Journals (Sweden)

    Paul eGringras

    2015-10-01

    Full Text Available ObjectiveIn an effort to enhance the efficiency, brightness and contrast of light-emitting (LE devices during the day, displays often generate substantial short-wavelength (blue-enriched light emissions that can adversely affect sleep. We set out to verify the extent of such short-wavelength emissions, produced by a tablet (iPad Air, e-reader (Kindle Paperwhite 1st generation and smartphone (iPhone 5s and to determine the impact of strategies designed to reduce these light emissions. SettingUniversity of Surrey dedicated chronobiology facility.MethodsFirstly, the spectral power of all the light-emitting (LE devices was assessed when displaying identical text. Secondly, we compared the text output with that of ‘Angry Birds’-a popular top 100 ‘App Store’ game. Finally we measured the impact of two strategies that attempt to reduce the output of short-wavelength light emissions. The first strategy employed an inexpensive commercially available pair of orange-tinted ‘blue-blocking’ glasses. The second tested an app designed to be ‘sleep-aware’ whose designers deliberately attempted to reduce blue-enriched light emissions.ResultsAll the LE devices shared very similar enhanced blue-light peaks when displaying text. This included the output from the backlit Kindle Paperwhite device. The spectra when comparing text to the Angry Birds game were also very similar, although the

  7. Current status of decommissioning projects and their strategies in advanced countries

    Energy Technology Data Exchange (ETDEWEB)

    Chung, U. S.; Lee, K. W.; Hwang, D. S.; Park, S. K.; Hwang, S. T.; Paik, S. T.; Park, J. H.; Choi, Y. D.; Chung, K. H.; Lee, K. I.; Hong, S. B

    2007-06-15

    At the Korea Atomic Energy Research Institute(KAERI), two projects for decommissioning of the research reactors and uranium conversion plant are carried out. The number of nuclear facilities to be dismantled will be much increased in future and the decommissioning industries will be enlarged. Keeping pace with this increasing tendency, each country formulated their own strategies and regulation systems, and applied their own technologies. The international organizations such as the IAEA and the OECD/NEA also prepared standards in technologies and regulation upon decommissioning and recommended to adopt them to the decommissioning projects. These strategies and technologies are very different country by country due to the different site dependent conditions and it will not be reasonable to evaluate their merits and weakness. The world wide status of the decommissioning, highlighted on that of 5 countries of USA, UK, France, Germany and Japan because they are advanced counties in nuclear industries, are summarized and their site specific conditions are evaluated. The scopes of the evaluation are decommissioning strategies, licensing procedures and requirements focused on decommissioning plan, waste management, technology development and so on. The detailed decommissioning progresses of several typical example sites were introduced. The activities on decommissioning field of the international organization, increased according to the enlarged decommissioning industries, are also summarized.

  8. [Whooping cough in Spain. Current epidemiology, prevention and control strategies. Recommendations by the Pertussis Working Group].

    Science.gov (United States)

    Campins, Magda; Moreno-Pérez, David; Gil-de Miguel, Angel; González-Romo, Fernando; Moraga-Llop, Fernando A; Arístegui-Fernández, Javier; Goncé-Mellgren, Anna; Bayas, José M; Salleras-Sanmartí, Lluís

    2013-04-01

    A large increase of pertussis incidence has been observed in recent years in countries with high vaccination coverage. Outbreaks of pertussis are increasingly being reported. The age presentation has a bipolar distribution: infants younger 6months that have not initiated or completed a vaccination schedule, and adolescents and adults, due to the lost of natural or vaccine immunity over time. These epidemiological changes justify the need to adopt new vaccination strategies in order to protect young infants and to reduce pertussis incidence in all age groups. Adolescents and adults immunization must be a priority. In the first group, strategy is easy to implement, and with a very low additional cost (to replace dT vaccine by dTap one). Adult vaccination may be more difficult to implement; dT vaccine decennial booster should be replaced by dTap. The immunization of household contacts of newborn infants (cocooning) is the strategy that has a most important impact on infant pertussis. Recently, pregnant women vaccination (after 20weeks of gestation) has been recommended in some countries as the most effective way to protect the newborn. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  9. Control Strategy for Three-Phase Grid-Connected PV Inverters Enabling Current Limitation Under Unbalanced Faults

    DEFF Research Database (Denmark)

    Afshari, Ehsan; Moradi, Gholam Reza; Rahimi, Ramin

    2017-01-01

    Power quality and voltage control are among the most important aspects of the grid-connected power converter operation under faults. Non-sinusoidal current is injected during unbalanced voltage sag and active or/and reactive power includes double frequency content. This paper introduces a novel...... control strategy to mitigate the double grid frequency oscillations in the active power and dc-link voltage of the two-stage three-phase grid-connected Photovoltaic (PV) inverters during unbalanced faults. With the proposed control method, PV inverter injects sinusoidal currents under unbalanced grid...... faults. In addition, an efficient and easy-to-implement current limitation method is introduced, which can effectively limit the injected currents to the rated value during faults. In this case, the fault-ride-through operation is ensured and it will not trigger the overcurrent protection. A non...

  10. Prevention of supine hypotensive syndrome in pregnant women undergoing computed tomography - A national survey of current practice

    International Nuclear Information System (INIS)

    McMahon, Michelle A.; Fenwick, Alison; Banks, Amelia; Dineen, Robert A.

    2009-01-01

    Aim: Supine hypotensive syndrome (SHS) can occur in women in the second half of pregnancy due to compression of the aorta and inferior vena cava by the gravid uterus. This results in a decrease in cardiac output with effects ranging from transient asymptomatic hypotension to cardiovascular collapse. SHS can be easily avoided by left lateral tilt positioning. We undertook a nationwide survey to assess the awareness amongst senior computed tomography (CT) radiographers of the potential risk of SHS in women in this patient group, and to identify the extent to which preventative practices and protocols are in place. Methods and materials: A questionnaire was sent to superintendent CT radiographers at all acute NHS Trusts in England and Wales examining awareness of the risk of SHS and the preventative practices and protocols currently used. Results: Completed questionnaires were received from 64% institutions. Of respondents who scan women in this patient group, only 44% were aware of the risk of SHS. No institution had a written protocol specifying positioning of women in this patient group. Seventy-five percent of institutions never employed oblique positioning. Eighty-five percent felt that specific guidelines from the Society of Radiographers or Royal College of Radiologists would be helpful. Conclusion: Current awareness and practices for preventing this easily avoidable but potentially harmful condition are inadequate. Central guidance would be welcomed by a large majority of respondents.

  11. Prevention of supine hypotensive syndrome in pregnant women undergoing computed tomography - A national survey of current practice

    Energy Technology Data Exchange (ETDEWEB)

    McMahon, Michelle A.; Fenwick, Alison [Department of Diagnostic Imaging, Queen' s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH (United Kingdom); Banks, Amelia [Department of Anaesthesia, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB (United Kingdom); Dineen, Robert A. [Department of Diagnostic Imaging, Queen' s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH (United Kingdom)], E-mail: Robert.dineen@nhs.net

    2009-05-15

    Aim: Supine hypotensive syndrome (SHS) can occur in women in the second half of pregnancy due to compression of the aorta and inferior vena cava by the gravid uterus. This results in a decrease in cardiac output with effects ranging from transient asymptomatic hypotension to cardiovascular collapse. SHS can be easily avoided by left lateral tilt positioning. We undertook a nationwide survey to assess the awareness amongst senior computed tomography (CT) radiographers of the potential risk of SHS in women in this patient group, and to identify the extent to which preventative practices and protocols are in place. Methods and materials: A questionnaire was sent to superintendent CT radiographers at all acute NHS Trusts in England and Wales examining awareness of the risk of SHS and the preventative practices and protocols currently used. Results: Completed questionnaires were received from 64% institutions. Of respondents who scan women in this patient group, only 44% were aware of the risk of SHS. No institution had a written protocol specifying positioning of women in this patient group. Seventy-five percent of institutions never employed oblique positioning. Eighty-five percent felt that specific guidelines from the Society of Radiographers or Royal College of Radiologists would be helpful. Conclusion: Current awareness and practices for preventing this easily avoidable but potentially harmful condition are inadequate. Central guidance would be welcomed by a large majority of respondents.

  12. Transcranial direct current stimulation reduces food-craving and measures of hyperphagia behavior in participants with Prader-Willi syndrome.

    Science.gov (United States)

    Bravo, Gabriela L; Poje, Albert B; Perissinotti, Iago; Marcondes, Bianca F; Villamar, Mauricio F; Manzardo, Ann M; Luque, Laura; LePage, Jean F; Stafford, Diane; Fregni, Felipe; Butler, Merlin G

    2016-03-01

    Prader-Willi syndrome (PWS) is a neurodevelopmental genetic disorder characterized by intellectual disabilities and insatiable appetite with compulsive eating leading to severe obesity with detrimental health consequences. Transcranial direct current stimulation (tDCS) has been shown to modulate decision-making and cue-induced food craving in healthy adults. We conducted a pilot double blind, sham-controlled, multicenter study of tDCS modulation of food drive and craving in 10 adult PWS participants, 11 adult obese (OB) and 11 adult healthy-weight control (HWC) subjects. PWS and OB subjects received five consecutive daily sessions of active or sham tDCS over the right dorsolateral prefrontal cortex (DLPFC), while HWC received a single sham and active tDCS in a crossover design. Standardized psychometric instruments assessed food craving, drive and hyperphagia by self-report and caregiver assessment over 30 days. Robust baseline differences were observed in severity scores for the Three-Factor Eating Questionnaire (TFEQ) and Dykens Hyperphagia Questionnaire (DHQ) for PWS compared to HWC while obese participants were more similar to HWC. Active tDCS stimulation in PWS was associated with a significant change from baseline in TFEQ Disinhibition (Factor II) (Ƶ = 1.9, P food drive and behaviors impacting hyperphagia in PWS. Transcranial direct current stimulation may represent a straight-forward, low risk and low cost method to improve care, management and quality of life in PWS. © 2015 Wiley Periodicals, Inc.

  13. Current controversies on the role of behavior therapy in Tourette Syndrome

    Science.gov (United States)

    Scahill, Lawrence; Woods, Douglas W.; Himle, Michael B.; Peterson, Alan L.; Wilhelm, Sabine; Piacentini, John C.; McNaught, Kevin; Walkup, John T.; Mink, Jonathan W.

    2014-01-01

    Comprehensive Behavioral Intervention for Tics (CBIT) is a safe and effective treatment for managing the tics of TS. In contrast to most current medications used for the treatment of tics, the efficacy of CBIT has been demonstrated in two relatively large, multisite trials. It also shows durability of benefit over time. Similar to psychopharmacological intervention, skilled practitioners are required to implement the intervention. Despite concerns about the effort required to participate in CBIT, patients with TS and parents of children with TS appear willing to meet the requirements of the CBIT program. Efforts are underway to increase the number of trained CBIT providers in the United States. Based on available evidence, recent published guidelines suggest that CBIT can be considered a first-line treatment for persons with a tic disorders. PMID:23681719

  14. STRATEGIES OF COMPLETE ORAL REHABILITATION IN PATIENTS WITH DISFUNCTIONAL SYNDROM OF THE STOMATOGNATE SYSTEM

    Directory of Open Access Journals (Sweden)

    Vasile BURLUI

    2015-12-01

    Full Text Available The complete oral and dental rehabilitation (ROC or (CODR requires an advanced understanding level, based on the capacity to prepare and successfully fix the complete strategy for the complex oral rehabilitation had in view.The method applied was to subject a representative group of patients to the algorithm of diagnosis and clinical solution. The strategies of complete oral rehabilitation applied included surgical-periodontal, implanto-surgical, implanto-prosthetic rehabilitation techniques.

  15. Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial

    Science.gov (United States)

    Bayram, Neriman; van Wely, Madelon; Kaaijk, Eugenie M; Bossuyt, Patrick M M; van der Veen, Fulco

    2004-01-01

    Objective To compare the effectiveness of an electrocautery strategy with ovulation induction using recombinant follicle stimulating hormone in patients with polycystic ovary syndrome. Design Randomised controlled trial. Setting Secondary and tertiary hospitals in the Netherlands. Participants 168 patients with clomiphene citrate resistant polycystic ovary syndrome: 83 were allocated electrocautery and 85 were allocated recombinant follicle stimulating hormone. Intervention Laparoscopic electrocautery of the ovaries followed by clomiphene citrate and recombinant follicle stimulating hormone if anovulation persisted, or induction of ovulation with recombinant follicle stimulating hormone. Main outcome measure Ongoing pregnancy within 12 months. Results. The cumulative rate of ongoing pregnancy after recombinant follicle stimulating hormone was 67%. With only electrocautery it was 34%, which increased to 49% after clomiphene citrate was given. Subsequent recombinant follicle stimulating hormone increased the rate to 67% at 12 months (rate ratio 1.01, 95% confidence interval 0.81 to 1.24). No complications occurred from electrocautery with or without clomiphene citrate. Patients allocated to electrocautery had a significantly lower risk of multiple pregnancy (0.11, 0.01 to 0.86). Conclusion The ongoing pregnancy rate from ovulation induction with laparoscopic electrocautery followed by clomiphene citrate and recombinant follicle stimulating hormone if anovulation persisted, or recombinant follicle stimulating hormone, seems equivalent to ovulation induction with recombinant follicle stimulating hormone, but the former procedure carries a lower risk of multiple pregnancy. PMID:14739186

  16. Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Scanlon ML

    2013-01-01

    Full Text Available Michael L Scanlon,1,2 Rachel C Vreeman1,21Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; 2USAID, Academic Model Providing Access to Healthcare (AMPATH Partnership, Eldoret, KenyaAbstract: The rollout of antiretroviral therapy (ART significantly reduced human immunodeficiency virus (HIV-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home- and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a

  17. Jabs and barbs: ways to address misleading vaccination and immunisation information using currently available strategies.

    Science.gov (United States)

    Wardle, Jon; Stewart, Cameron; Parker, Malcolm

    2013-09-01

    Misleading vaccination information undermines confidence in vaccination and may lead to reductions in the effectiveness of vaccination programs. A number of regulatory techniques can be employed to challenge the spread of false information, including health care complaints, therapeutic goods laws, consumer protection laws and professional discipline. This article examines three case studies involving the publication of anti-vaccination information by non-professionally aligned organisations, by non-registered health professionals, and by registered health professionals under the National Law. The article examines the effectiveness of different regulatory responses and makes suggestions for future strategies to deal with the publication of demonstrably false information regarding vaccination.

  18. Current Capabilities, Requirements and a Proposed Strategy for Interdependency Analysis in the UK

    Science.gov (United States)

    Bloomfield, Robin; Chozos, Nick; Salako, Kizito

    The UK government recently commissioned a research study to identify the state-of-the-art in Critical Infrastructure modelling and analysis, and the government/industry requirements for such tools and services. This study (Cetifs) concluded with a strategy aiming to bridge the gaps between the capabilities and requirements, which would establish interdependency analysis as a commercially viable service in the near future. This paper presents the findings of this study that was carried out by CSR, City University London, Adelard LLP, a safety/security consultancy and Cranfield University, defense academy of the UK.

  19. Current strategies for preventing renal dysfunction in patients with heart failure: a heart failure stage approach

    Science.gov (United States)

    Issa, Victor Sarli; Andrade, Lúcia; Bocchi, Edimar Alcides

    2013-01-01

    Renal dysfunction is common during episodes of acute decompensated heart failure, and historical data indicate that the mean creatinine level at admission has risen in recent decades. Different mechanisms underlying this change over time have been proposed, such as demographic changes, hemodynamic and neurohumoral derangements and medical interventions. In this setting, various strategies have been proposed for the prevention of renal dysfunction with heterogeneous results. In the present article, we review and discuss the main aspects of renal dysfunction prevention according to the different stages of heart failure. PMID:23644863

  20. Current scenario of antibiotic resistance and latest strategies to overcome it

    Directory of Open Access Journals (Sweden)

    Mohankumar J Megha

    2014-09-01

    Full Text Available Antibiotic resistance in microorganisms has become a critical health issue these days and has evolved to become a worldwide health threat. Over a decade, the resistance level of bacteria has increased many folds due to various factors, accounting to the added pressure on the environmental resistome. Infections that are resistant to these antibiotics show potentially devastating effects on public health, often affecting developing countries. This review focuses on the present scenario of antibiotic resistance and enlists some of the strategies to combat this global community threat.

  1. No prognostic significance of chronic infection with Chlamydia pneumoniae in acute coronary syndromes: insights from the Global Utilization of Strategies to Open Occluded Arteries IV Acute Coronary Syndromes trial

    DEFF Research Database (Denmark)

    Westerhout, Cynthia M; Gnarpe, Judy; Chang, Wei-Ching

    2007-01-01

    case-control substudy of the Global Utilization of Strategies to Open Occluded Arteries IV Acute Coronary Syndromes trial, 295 cases (30-day death/myocardial infarction [MI]) were matched by age, sex, baseline creatine kinase-myocardial kinase, and smoking status with 295 control subjects. To test...

  2. Astigmatism treatment during phacoemulsification: a review of current surgical strategies and their rationale

    Directory of Open Access Journals (Sweden)

    Giuliano de Oliveira Freitas

    2013-12-01

    Full Text Available Preexisting corneal astigmatism, present at the time of cataract surgery, is reviewed in detail throughout this article on its most important aspects such as occurrence rates, clinical relevance and current treatment options. Special emphasis is given to the latter aspect. Each method's rationale, advantage and limitation ishigh lightened. Comparisons between treatment options, whenever possible, are also provided.

  3. Risk assessment with current deployment strategies for fusiform rust-resistant loblolly and slash pines

    Science.gov (United States)

    Floyd Bridgwater; Tom Kubisiak; Tom Byram; Steve Mckeand

    2004-01-01

    In the southeastern USA, fusiform rust resistant loblolly and slash pines may be deployed as 1) ulked seed orchard mixes. 2) half-sibling (sib) family mixtures. 3) single half-sib families. 4) full-sib cross seeds or as 6) clones of individual genotypes. These deployment types are respectively greater genetic gains from higher selection intensity. Currently, bulked...

  4. Educating physicians in evidence based medicine: current practices and curricular strategies

    NARCIS (Netherlands)

    Maggio, L.A.

    2015-01-01

    Evidence based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM is an expectation of professional healthcare and requisite component in many medical school curricula. Yet, despite

  5. Evaluation of low level laser and interferential current in the therapy of complex regional pain syndrome by infrared thermographic camera

    Directory of Open Access Journals (Sweden)

    Kocić Mirjana

    2010-01-01

    Full Text Available Background/Aim. Complex regional pain syndrome type I (CRPS I is characterized by continuous regional pain, disproportional according to duration and intensity and to the sort of trauma or other lesion it was caused by. The aim of the study was to evaluate and compare, by using thermovison, the effects of low level laser therapy and therapy with interferential current in treatment of CRPS I. Methods. The prospective randomized controlled clinical study included 45 patients with unilateral CRPS I, after a fracture of the distal end of the radius, of the tibia and/or the fibula, treated in the Clinical Centre in Nis from 2004 to 2007. The group A consisted of 20 patients treated by low level laser therapy and kinesy-therapy, while the patients in the group B (n = 25 were treated by interferential current and kinesy-therapy. The regions of interest were filmed by a thermovision camera on both sides, before and after the 20 therapeutic procedures had been applied. Afterwards, the quantitative analysis and the comparing of thermograms taken before and after the applied therapy were performed. Results. There was statistically significant decrease of the mean maximum temperature difference between the injured and the contralateral extremity after the therapy in comparison to the status before the therapy, with the patients of the group A (p < 0.001 as well as those of the group B (p < 0.001. The decrease was statistically significantly higher in the group A than in the group B (p < 0.05. Conclusions. By the use of the infrared thermovision we showed that in the treatment of CRPS I both physical medicine methods were effective, but the effectiveness of laser therapy was statistically significantly higher compared to that of the interferential current therapy.

  6. Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.

    Science.gov (United States)

    Boyer, Nathan; Gupta, Rajesh; Schevchuck, Alex; Hindnavis, Vindhya; Maliske, Seth; Sheldon, Mark; Drachman, Douglas; Yeghiazarians, Yerem

    2014-06-01

    Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.

  7. Imaging in syndrome complex diabetes mellitus. Current standards and future perspectives; Bildgebung im Syndromkomplex Diabetes mellitus. Stellenwert und Chancen

    Energy Technology Data Exchange (ETDEWEB)

    Hetterich, H.; Schafnitzel, A. [Klinikum der Ludwig-Maximilians-Universitaet, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Bamberg, F. [Eberhard-Karls-Universitaet, Abteilung fuer Diagnostische und Interventionelle Radiologie, Tuebingen (Germany)

    2015-04-01

    Diabetes mellitus is a highly prevalent multisystemic disorder with numerous potential complications and substantial socioeconomic consequences. In many cases, the patient history, physical examination and laboratory tests are not sufficient for a comprehensive evaluation of complicating disorders. Imaging modalities, such as sonography, computed tomography (CT) and magnetic resonance imaging (MRI) are of major significance in the evaluation of complicating disorders of diabetes according to current guidelines. Examples include assessment of coronary artery disease, peripheral artery disease, stroke and diabetic foot syndrome. Technical developments allow a substantial reduction in radiation dose and scan time in CT and MRI, respectively and could therefore justify a broader application in this patient population. In the future CT and MRI could also be used for the early detection of diabetic complications. Furthermore, they could also be used for risk stratification, e.g. measurement of hepatic fat content and evaluation of atherosclerosis in whole body MRI. Prior to widespread application of advanced imaging techniques in this patient population, improved outcomes with respect to survival, quality of life and cost-effectiveness need to be demonstrated. Diagnostic imaging modalities for the evaluation of the syndrome complex of diabetic disorders should be used according to the current guidelines but the use is predicted to increase given the high potential in this population. (orig.) [German] Diabetes mellitus ist eine hochpraevalente Multisystemerkrankung mit zahlreichen Komplikationen und bedeutenden soziooekonomischen Konsequenzen. Die Folgeerkrankungen koennen oft nicht abschliessend mittels Anamnese, koerperlicher Untersuchung und laborchemischen Verfahren evaluiert werden. Radiologische Verfahren wie die Sonographie, Computertomographie (CT) und Magnetresonanztomographie (MRT) haben gemaess verschiedener Leitlinien einen festen Stellenwert bei der

  8. A Grid Connected Transformerless Inverter and its Model Predictive Control Strategy with Leakage Current Elimination Capability

    Directory of Open Access Journals (Sweden)

    J. Fallah Ardashir

    2017-06-01

    Full Text Available This paper proposes a new single phase transformerless Photovoltaic (PV inverter for grid connected systems. It consists of six power switches, two diodes, one capacitor and filter at the output stage. The neutral of the grid is directly connected to the negative terminal of the source. This results in constant common mode voltage and zero leakage current. Model Predictive Controller (MPC technique is used to modulate the converter to reduce the output current ripple and filter requirements. The main advantages of this inverter are compact size, low cost, flexible grounding configuration. Due to brevity, the operating principle and analysis of the proposed circuit are presented in brief. Simulation and experimental results of 200W prototype are shown at the end to validate the proposed topology and concept. The results obtained clearly verifies the performance of the proposed inverter and its practical application for grid connected PV systems.

  9. Current advances and strategies towards fully automated sample preparation for regulated LC-MS/MS bioanalysis.

    Science.gov (United States)

    Zheng, Naiyu; Jiang, Hao; Zeng, Jianing

    2014-09-01

    Robotic liquid handlers (RLHs) have been widely used in automated sample preparation for liquid chromatography-tandem mass spectrometry (LC-MS/MS) bioanalysis. Automated sample preparation for regulated bioanalysis offers significantly higher assay efficiency, better data quality and potential bioanalytical cost-savings. For RLHs that are used for regulated bioanalysis, there are additional requirements, including 21 CFR Part 11 compliance, software validation, system qualification, calibration verification and proper maintenance. This article reviews recent advances in automated sample preparation for regulated bioanalysis in the last 5 years. Specifically, it covers the following aspects: regulated bioanalysis requirements, recent advances in automation hardware and software development, sample extraction workflow simplification, strategies towards fully automated sample extraction, and best practices in automated sample preparation for regulated bioanalysis.

  10. Politics and strategies for radioactive waste management: current situation and perspective for Latin America

    International Nuclear Information System (INIS)

    Amaral, Eliana; Cruz, Paulo Ferruz; Gonzalez, Abel; Telleria, Diego

    2013-01-01

    In some countries of the Latin America Region, policy and national strategy are well established and documented, while in others there is not an explicit formal declaration, although they may be implicit in the content of the laws, regulations and existing guides; but they are not consolidated in a single document, making it difficult to put into practice by the Government institutions, the organisms responsible for the regulation and those responsible for the safe management of waste. For practical reasons, the work concentrates the situation in the Region with the waste from medical, industrial practices, research and production, which generate a common problem in the region. This document also contains some recommendations to improve the situation in this topic in the Region

  11. Current and emerging strategies for organophosphate decontamination: special focus on hyperstable enzymes.

    Science.gov (United States)

    Jacquet, Pauline; Daudé, David; Bzdrenga, Janek; Masson, Patrick; Elias, Mikael; Chabrière, Eric

    2016-05-01

    Organophosphorus chemicals are highly toxic molecules mainly used as pesticides. Some of them are banned warfare nerve agents. These compounds are covalent inhibitors of acetylcholinesterase, a key enzyme in central and peripheral nervous systems. Numerous approaches, including chemical, physical, and biological decontamination, have been considered for developing decontamination methods against organophosphates (OPs). This work is an overview of both validated and emerging strategies for the protection against OP pollution with special attention to the use of decontaminating enzymes. Considerable efforts have been dedicated during the past decades to the development of efficient OP degrading biocatalysts. Among these, the promising biocatalyst SsoPox isolated from the archaeon Sulfolobus solfataricus is emphasized in the light of recently published results. This hyperthermostable enzyme appears to be particularly attractive for external decontamination purposes with regard to both its catalytic and stability properties.

  12. Zero-Sequence Voltage Modulation Strategy for Multiparallel Converters Circulating Current Suppression

    DEFF Research Database (Denmark)

    Zhu, Rongwu; Liserre, Marco; Chen, Zhe

    2017-01-01

    A zero-sequence circulating current (ZSCC) is typically generated among the multiparallel converters that share the common dc link and ac side without isolated transformers under the space vector modulation (SVM), due to the injected third-order zero-sequence voltage (ZSV). This paper analyzes SVM...... references and filter inductances. The simulation and experimental results based on the parallel converters clearly verify the effectiveness of the proposed control....

  13. New Insights into Biology, Prognostic Factors, and Current Therapeutic Strategies in Chronic Lymphocytic Leukemia

    OpenAIRE

    Smolewski, Piotr; Witkowska, Magdalena; Korycka-Wołowiec, Anna

    2013-01-01

    Chronic lymphocytic leukemia (CLL) is characterized by the clonal proliferation and accumulation of mature B lymphocytes. CLL cells show an antiapoptotic profile, suggesting the important role of apoptosis inhibition in the disease development. However, there is some population of proliferating CLL cells, which may also play a role in progression of the disease. There are several newer, biological prognostic factors in CLL. Currently, cytogenetic abnormalities with different prognostic values...

  14. Simulated Design Strategies for SPECT Collimators to Reduce the Eddy Currents Induced by MRI Gradient Fields

    Science.gov (United States)

    Samoudi, Amine M.; Van Audenhaege, Karen; Vermeeren, Günter; Verhoyen, Gregory; Martens, Luc; Van Holen, Roel; Joseph, Wout

    2015-10-01

    Combining single photon emission computed tomography (SPECT) with magnetic resonance imaging (MRI) requires the insertion of highly conductive SPECT collimators inside the MRI scanner, resulting in an induced eddy current disturbing the combined system. We reduced the eddy currents due to the insert of a novel tungsten collimator inside transverse and longitudinal gradient coils. The collimator was produced with metal additive manufacturing, that is part of a microSPECT insert for a preclinical SPECT/MRI scanner. We characterized the induced magnetic field due to the gradient field and adapted the collimators to reduce the induced eddy currents. We modeled the x-, y-, and z-gradient coil and the different collimator designs and simulated them with FEKO, a three-dimensional method of moments / finite element methods (MoM/FEM) full-wave simulation tool. We used a time analysis approach to generate the pulsed magnetic field gradient. Simulation results show that the maximum induced field can be reduced by 50.82% in the final design bringing the maximum induced magnetic field to less than 2% of the applied gradient for all the gradient coils. The numerical model was validated with measurements and was proposed as a tool for studying the effect of a SPECT collimator within the MRI gradient coils.

  15. The Efficacy of Rehearsal Strategy on Auditory Short-Term Memory of Educable 5 to 8 Years Old Children with Down Syndrome

    Directory of Open Access Journals (Sweden)

    Esmaeil Esmaieli

    2014-03-01

    Full Text Available Objective: One of the problems of children with Down syndrome is their low performance on retention of information and its recall in the memory. The present study aimed to determine the efficacy of rehearsal strategy on auditory short-term memory of educable 5 to 8 years old children with Down syndrome. Materials & Methods: In this quasi-experimental study, 24 children (14 boys and 10 girls were selected in convenience from Iranian Down Syndrome Charity Association and evaluated by Raven’s Intelligence Progressive Matrices. Then, children were assigned into two experimental and control groups randomly (each contained 12 individuals. Experimental group participated in 8 group sessions (two sessions per week, each lasting 30 minutes and trained by rehearsal strategy. All subjects were evaluated by Expressive-Auditory Memory Sequence Test before and after intervention sessions. Data were analyzed by multiple analysis of covariance.  Results: The results of analysis of covariance showed that rehearsal strategy have led to increase of digit span, word span and auditory short-term memory (P<0.01 in experimental group compared to control group. Conclusion: It can be concluded that rehearsal strategy training is an effective method on promotion of digit span, word span and auditory short-term memory of children with Down syndrome and implies important consequences for their education.

  16. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

    Directory of Open Access Journals (Sweden)

    Fernandez RC

    2018-02-01

    Full Text Available Renae C Fernandez,1–3 Vivienne M Moore,1,3,4 Emer M Van Ryswyk,5 Tamara J Varcoe,1,2 Raymond J Rodgers,1,2 Wendy A March,1,3 Lisa J Moran,1,6 Jodie C Avery,1,2 R Doug McEvoy,5,7 Michael J Davies1,2 1The University of Adelaide, Robinson Research Institute, Adelaide, SA, Australia; 2The University of Adelaide, Adelaide Medical School, Adelaide, SA, Australia; 3The University of Adelaide, School of Public Health, Adelaide, SA, Australia; 4The University of Adelaide, Fay Gale Centre for Research on Gender, Adelaide, SA, Australia; 5Adelaide Institute for Sleep Health, Flinders Centre for Research Excellence, Flinders University of South Australia, Bedford Park, SA, Australia; 6Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; 7Adelaide Sleep Health, Southern Adelaide Local Health Network, Repatriation General Hospital, Daw Park, SA, Australia Abstract: Polycystic ovary syndrome (PCOS is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight. There are several, possibly bidirectional, pathways through which PCOS is associated with sleep disturbances. The pathophysiology of PCOS involves hyperandrogenemia, a form of insulin resistance unique to affected women, and possible changes in cortisol and melatonin secretion, arguably reflecting altered hypothalamic

  17. Off-loading strategies in diabetic foot syndrome-evaluation of different devices.

    Science.gov (United States)

    Götz, Jürgen; Lange, Mario; Dullien, Silvia; Grifka, Joachim; Hertel, Gernot; Baier, Clemens; Koeck, Franz

    2017-02-01

    Diabetic foot syndrome is one of the most dreaded complications in diabetes mellitus. The purpose of this study was to assess the value of different offloading devices compared to walking in barefoot condition and in normal shoes both in healthy subjects and in patients with diabetes and neuropathy. Twenty patients with diabetes and polyneuropathy and ten healthy probands were included. Pedobarographic examination was performed in barefoot condition, with sneakers, postoperative shoes, Aircast® Diabetic Pneumatic Walker™ and VACO®diaped. In the diabetic group, a total contact cast was additionally tested. The most effective reduction of force was achieved by TCC (75%) and VACOdiaped (64.3%) with the VACO®diaped resulting in the most homogeneous distribution of forces all over the foot. A customized device like the TCC is still the most proven offloading device. However, a removable cast walker being based on vacuum pads and a cushioning sole, provides better results concerning force distribution.

  18. Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies

    Science.gov (United States)

    Moore, Vivienne M; Van Ryswyk, Emer M; Varcoe, Tamara J; Rodgers, Raymond J; March, Wendy A; Moran, Lisa J; Avery, Jodie C; McEvoy, R Doug; Davies, Michael J

    2018-01-01

    Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting the reproductive, metabolic and psychological health of women. Clinic-based studies indicate that sleep disturbances and disorders including obstructive sleep apnea and excessive daytime sleepiness occur more frequently among women with PCOS compared to comparison groups without the syndrome. Evidence from the few available population-based studies is supportive. Women with PCOS tend to be overweight/obese, but this only partly accounts for their sleep problems as associations are generally upheld after adjustment for body mass index; sleep problems also occur in women with PCOS of normal weight. There are several, possibly bidirectional, pathways through which PCOS is associated with sleep disturbances. The pathophysiology of PCOS involves hyperandrogenemia, a form of insulin resistance unique to affected women, and possible changes in cortisol and melatonin secretion, arguably reflecting altered hypothalamic–pituitary–adrenal function. Psychological and behavioral pathways are also likely to play a role, as anxiety and depression, smoking, alcohol use and lack of physical activity are also common among women with PCOS, partly in response to the distressing symptoms they experience. The specific impact of sleep disturbances on the health of women with PCOS is not yet clear; however, both PCOS and sleep disturbances are associated with deterioration in cardiometabolic health in the longer term and increased risk of type 2 diabetes. Both immediate quality of life and longer-term health of women with PCOS are likely to benefit from diagnosis and management of sleep disorders as part of interdisciplinary health care. PMID:29440941

  19. MECP2 variation in Rett syndrome-An overview of current coverage of genetic and phenotype data within existing databases.

    Science.gov (United States)

    Townend, Gillian S; Ehrhart, Friederike; van Kranen, Henk J; Wilkinson, Mark; Jacobsen, Annika; Roos, Marco; Willighagen, Egon L; van Enckevort, David; Evelo, Chris T; Curfs, Leopold M G

    2018-04-27

    Rett syndrome (RTT) is a monogenic rare disorder that causes severe neurological problems. In most cases, it results from a loss-of-function mutation in the gene encoding methyl-CPG-binding protein 2 (MECP2). Currently, about 900 unique MECP2 variations (benign and pathogenic) have been identified and it is suspected that the different mutations contribute to different levels of disease severity. For researchers and clinicians, it is important that genotype-phenotype information is available to identify disease-causing mutations for diagnosis, to aid in clinical management of the disorder, and to provide counseling for parents. In this study, 13 genotype-phenotype databases were surveyed for their general functionality and availability of RTT-specific MECP2 variation data. For each database, we investigated findability and interoperability alongside practical user functionality, and type and amount of genetic and phenotype data. The main conclusions are that, as well as being challenging to find these databases and specific MECP2 variants held within, interoperability is as yet poorly developed and requires effort to search across databases. Nevertheless, we found several thousand online database entries for MECP2 variations and their associated phenotypes, diagnosis, or predicted variant effects, which is a good starting point for researchers and clinicians who want to provide, annotate, and use the data. © 2018 The Authors. Human Mutation published by Wiley Periodicals, Inc.

  20. Can anti-Mullerian hormone replace ultrasonographic evaluation in polycystic ovary syndrome? A review of current progress

    Directory of Open Access Journals (Sweden)

    Awadhesh Kumar Singh

    2015-01-01

    Full Text Available Several studies over the past decade have now consistently indicated that the serum anti-Mullerian hormone (AMH levels are at least 2–3-fold higher in the patients with polycystic ovary syndrome (PCOS, which also corresponds to the increased number of AMH producing preantral and small antral follicles. Moreover, AMH levels have been found to be associated in direct proportion to the follicle numbers per ovary or antral follicular count, assessed by the transvaginal ultrasound (TVS. Furthermore, AMH correlates directly with the rising serum testosterone and luteinizing hormone levels in PCOS. Hence, serum AMH in women with oligo-anovulation and/or hyperandrogenemia could indicate the presence of underlying PCOS, when reliable TVS is not feasible, or not acceptable, either due to the virginal status or psycho-social issue. In addition, the imaging quality of abdominal ultrasound is often impaired by obesity, which typically occurs in PCOS women. Indeed, PCOS occurs most commonly in young females who cannot be subjected to invasive TVS for various reasons; therefore, a desirable alternative to TVS is urgently required to diagnose the most prevalent endocrine abnormality of young women. This review will analyze the currently available evidence regarding the role of AMH in the diagnosis of PCOS.

  1. Current Strategies for the Detoxification of Jatropha curcas Seed Cake: A Review.

    Science.gov (United States)

    Gomes, Taisa G; Hadi, Sámed I I A; Costa Alves, Gabriel S; Mendonça, Simone; De Siqueira, Felix G; Miller, Robert N G

    2018-03-21

    Jatropha curcas is an important oilseed plant, with considerable potential in the development of biodiesel. Although Jatropha seed cake, the byproduct of oil extraction, is a residue rich in nitrogen, phosphorus, potassium, and carbon, with high protein content suitable for application in animal feed, the presence of toxic phorbol esters limits its application in feed supplements and fertilizers. This review summarizes the current methods available for detoxification of this residue, based upon chemical, physical, biological, or combined processes. The advantages and disadvantages of each process are discussed, and future directions involving genomic and proteomic approaches for advancing our understanding of biodegradation processes involving microorganisms are highlighted.

  2. E-waste management challenges in Iran: presenting some strategies for improvement of current conditions.

    Science.gov (United States)

    Taghipour, Hassan; Nowrouz, Parviz; Jafarabadi, Mohamad Asghari; Nazari, Jalil; Hashemi, Ahmad Asl; Mosaferi, Mohammad; Dehghanzadeh, Reza

    2012-11-01

    E-waste is one of the fastest-growing waste streams in Iran, owing to an increase in consumption of electrical and electronic equipment. Nevertheless, as is the case in some other countries, E-waste management has not received sufficient attention. For the successful implementation of any waste management plan (including an E-waste management plan), the availability of sufficient and accurate information on the quantities and composition of the waste generated and on current management conditions is a fundamental prerequisite. At present, in Iran, there is no available and accurate information that describes the characteristics and generation rate of E-waste or the actual practice of management and handling of the waste. For this initial study, eight electronic products were selected for the determination of their E-waste generation rate in the country, and two cities, Tehran and Tabriz, were selected for assessment of the current condition of E-waste management. The study found that the amount of E-waste generation in the country for the eight selected electronic items alone was 115,286, 112,914 and 115,151 metric tons in 2008, 2009 and 2010, respectively. Of the types of electronic items included in the study, televisions, with an average of 42.42%, and PCs, with an average of 32.66% accounted for the greatest proportions of the total mass of E-waste generated during 2008-2010. Currently, despite the fact that primary legislation for E-waste management (as part of general waste legislation) exists in Iran, this primary legislation has not yet been implemented. In practical terms, there is no definite policy or plan for the allocation of funds to prepare suitable equipment and facilities for the management and recycling of E-waste at the end of the products' useful life. Proposed improvements in current conditions are identified, first by considering other countries' experiences and then suggesting specific practical policies, rules, and regulations that should be

  3. Schistosomiasis in the Amazon region: is the current diagnostic strategy still appropriate?

    Directory of Open Access Journals (Sweden)

    Sergei Rodrigo Magalhães de Sousa

    Full Text Available Abstract INTRODUCTION: This study analyzed the performance of the Kato Katz technique in detecting intestinal schistosomiasis in the State of Pará. METHODS: Of three stool samples provided by each of 380 participants, a total of 16 Kato Katz slides were examined to define the reference value (RV of positives for comparisons. RESULTS: The RV revealed 37 (9.7% infected participants in contrast to 10 (2.6% according to a single slide. CONCLUSIONS: This significant underestimation of the infection rate gives reason to discuss if the current classification of prevalence levels reflects the real situation, principally in low transmission areas, like the Amazon region.

  4. Challenging the current strategy of radiological protection of the environment: arguments for an ecosystem approach

    International Nuclear Information System (INIS)

    Brechignac, F.; Doi, Masahiro

    2009-01-01

    The system of radiological protection of the environment that is currently under development is one contribution to the general need to adequately protect the environment against stress. Dominated by operational goals, it emphasizes conceptual and methodological approaches that are readily accessible today: reference organisms supported by individual-based traditional ecotoxicological data. Whilst there are immediate advantages to this approach (pragmatism, consistency with other approaches in use for man and biota), there are also clear limitations, especially in a longer run perspective, that need to be acknowledged and further considered. One can mention a few: uncertainties generated by the need for various extrapolations (from lower to higher levels of biological organisation, ...), various features missed such as potential ecological impact through impairment of ecosystem processes, trans-generational impacts as mediated through genomic instability, indirect effects mediated through trophic interactions or disruption of ecological balances, ... Such limitations have already been faced in other fields of environmental protection against other stressors, pushing a number of environment professionals to assign stronger emphasis on more systemic approaches. This review discusses the advantages and limitations of the current approach designed for the radiological protection of non-human biota in the broader context of environment protection as a whole, with especial reference to upcoming trends and evolutions. This leads in particular to advocating the need to boost scientific and methodological approaches featuring the ecosystem concept as a mean to access a unified goal of protection: preserving life sustainability through protection of ecosystem structure and functioning.

  5. On a numerical strategy to compute gravity currents of non-Newtonian fluids

    International Nuclear Information System (INIS)

    Vola, D.; Babik, F.; Latche, J.-C.

    2004-01-01

    This paper is devoted to the presentation of a numerical scheme for the simulation of gravity currents of non-Newtonian fluids. The two dimensional computational grid is fixed and the free-surface is described as a polygonal interface independent from the grid and advanced in time by a Lagrangian technique. Navier-Stokes equations are semi-discretized in time by the Characteristic-Galerkin method, which finally leads to solve a generalized Stokes problem posed on a physical domain limited by the free surface to only a part of the computational grid. To this purpose, we implement a Galerkin technique with a particular approximation space, defined as the restriction to the fluid domain of functions of a finite element space. The decomposition-coordination method allows to deal without any regularization with a variety of non-linear and possibly non-differentiable constitutive laws. Beside more analytical tests, we revisit with this numerical method some simulations of gravity currents of the literature, up to now investigated within the simplified thin-flow approximation framework

  6. [Development strategy of Paris based on combination of domestic patent and current resource application and development].

    Science.gov (United States)

    Zhao, Fei-Ya; Tao, Ai-En; Xia, Cong-Long

    2018-01-01

    Paris is a commonly used traditional Chinese medicine (TCM), and has antitumor, antibacterial, sedative, analgesic and hemostatic effects. It has been used as an ingredient of 81 Chinese patent medicines, with a wide application and large market demand. Based on the data retrieved from state Intellectual Property Office patent database, a comprehensive analysis was made on Paris patents, so as to explore the current features of Paris patents in the aspects of domestic patent output, development trend, technology field distribution, time dimension, technology growth rate and patent applicant, and reveal the development trend of China's Paris industry. In addition, based on the current Paris resource application and development, a sustainable, multi-channel and multi-level industrial development approach was built. According to the results, studies of Paris in China are at the rapid development period, with a good development trend. However, because wild Paris resources tend to be exhausted, the studies for artificial cultivation technology should be strengthened to promote the industrial development. Copyright© by the Chinese Pharmaceutical Association.

  7. Challenging the current strategy of radiological protection of the environment: arguments for an ecosystem approach

    Energy Technology Data Exchange (ETDEWEB)

    Brechignac, F., E-mail: francois.brechignac@irsn. [Institute for Radioprotection and Nuclear Safety (IRSN), Centre d' Etudes de Cadarache, Blg 229, 13115 Saint-Paul-lez-Durance (France); Doi, Masahiro [National Institute of Radiological Sciences, NIRS, Center for Radiation Protection, Regulatory Sciences Research Group, 4-9-1, Anagawa, Inage, Chiba, 263-8555 (Japan)

    2009-12-15

    The system of radiological protection of the environment that is currently under development is one contribution to the general need to adequately protect the environment against stress. Dominated by operational goals, it emphasizes conceptual and methodological approaches that are readily accessible today: reference organisms supported by individual-based traditional ecotoxicological data. Whilst there are immediate advantages to this approach (pragmatism, consistency with other approaches in use for man and biota), there are also clear limitations, especially in a longer run perspective, that need to be acknowledged and further considered. One can mention a few: uncertainties generated by the need for various extrapolations (from lower to higher levels of biological organisation, ...), various features missed such as potential ecological impact through impairment of ecosystem processes, trans-generational impacts as mediated through genomic instability, indirect effects mediated through trophic interactions or disruption of ecological balances, ... Such limitations have already been faced in other fields of environmental protection against other stressors, pushing a number of environment professionals to assign stronger emphasis on more systemic approaches. This review discusses the advantages and limitations of the current approach designed for the radiological protection of non-human biota in the broader context of environment protection as a whole, with especial reference to upcoming trends and evolutions. This leads in particular to advocating the need to boost scientific and methodological approaches featuring the ecosystem concept as a mean to access a unified goal of protection: preserving life sustainability through protection of ecosystem structure and functioning.

  8. Improving outcomes of refractory celiac disease – current and emerging treatment strategies

    Directory of Open Access Journals (Sweden)

    Woodward J

    2016-08-01

    Full Text Available Jeremy Woodward Department of Gastroenterology and Clinical Nutrition, Addenbrooke’s Hospital, Cambridge, UK Abstract: Intestinal inflammation and symptoms of celiac disease (CD usually respond well to gluten withdrawal, but rare cases are refractory to diet. Two types of refractory CD are discriminated on the basis of the presence or absence of an atypical population of mucosal lymphocytes that may progress to enteropathy-associated T-cell lymphoma. Challenges remain in the secure diagnosis of both types of refractory disease, and evidence on which to base treatment recommendations is flawed by the small numbers of reported patients and the use of different diagnostic strategies. Recent advances in our understanding of the mechanisms of the condition in conjunction with the development of immunomodulatory agents for managing other inflammatory diseases are helping to shape future approaches to targeted therapy. Progression will depend on collaboration and recruitment to trials. In the meantime, there is evidence to suggest that earlier diagnosis and better follow-up and management of CD may prevent the development of refractoriness. Keywords: celiac disease, gluten, small intestine, lymphoma, lymphocytes

  9. Regulation of phosphorus uptake and utilization: transitioning from current knowledge to practical strategies.

    Science.gov (United States)

    Hasan, Md Mahmudul; Hasan, Md Mainul; Teixeira da Silva, Jaime A; Li, Xuexian

    2016-01-01

    Phosphorus is a poorly bioavailable macronutrient that is essential for crop growth and yield. Overuse of phosphorus fertilizers results in low phosphorus use efficiency (PUE), has serious environmental consequences and accelerates the depletion of phosphorus mineral reserves. It has become extremely challenging to improve PUE while preserving global food supplies and maintaining environmental sustainability. Molecular and genetic analyses have revealed the primary mechanisms of phosphorus uptake and utilization and their relationships to phosphorus transporters, regulators, root architecture, metabolic adaptations, quantitative trait loci, hormonal signaling and microRNA. The ability to improve PUE requires a transition from this knowledge of molecular mechanisms and plant architecture to practical strategies. These could include: i) the use of arbuscular mycorrhizal fungal symbioses for efficient phosphorus mining and uptake; ii) intercropping with suitable crop species to achieve phosphorus activation and mobilization in the soil; and iii) tissue-specific overexpression of homologous genes with advantageous agronomic properties for higher PUE along with breeding for phosphorus-efficient varieties and introgression of key quantitative trait loci. More effort is required to further dissect the mechanisms controlling phosphorus uptake and utilization within plants and provide new insight into the means to efficiently improve PUE.

  10. Changing currents: a strategy for understanding and predicting the changing ocean circulation.

    Science.gov (United States)

    Bryden, Harry L; Robinson, Carol; Griffiths, Gwyn

    2012-12-13

    Within the context of UK marine science, we project a strategy for ocean circulation research over the next 20 years. We recommend a focus on three types of research: (i) sustained observations of the varying and evolving ocean circulation, (ii) careful analysis and interpretation of the observed climate changes for comparison with climate model projections, and (iii) the design and execution of focused field experiments to understand ocean processes that are not resolved in coupled climate models so as to be able to embed these processes realistically in the models. Within UK-sustained observations, we emphasize smart, cost-effective design of the observational network to extract maximum information from limited field resources. We encourage the incorporation of new sensors and new energy sources within the operational environment of UK-sustained observational programmes to bridge the gap that normally separates laboratory prototype from operational instrument. For interpreting the climate-change records obtained through a variety of national and international sustained observational programmes, creative and dedicated UK scientists should lead efforts to extract the meaningful signals and patterns of climate change and to interpret them so as to project future changes. For the process studies, individual scientists will need to work together in team environments to combine observational and process modelling results into effective improvements in the coupled climate models that will lead to more accurate climate predictions.

  11. The role of tramadol in current treatment strategies for musculoskeletal pain

    Science.gov (United States)

    Schug, Stephan A

    2007-01-01

    Non-selective and cyclooxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drugs (NSAIDs) have been the mainstay of treatment for musculoskeletal pain of moderate intensity. However, in addition to gastrointestinal and renal toxicity, an increased cardiovascular risk may be a class effect for all NSAIDs. Despite these safety risks and the acknowledged ceiling effect of NSAIDs, many doctors still use them to treat moderate, mostly musculoskeletal pain. Recent guidelines for treating osteoarthritis and low back pain, issued by numerous professional medical societies, recommend NSAIDs and COX-2 inhibitors only in strictly defined circumstances, at the lowest effective dose and for the shortest possible period of time. These recent guidelines bring more focus to the usage of paracetamol and opioids. But opioids still remain under-utilized, although they are effective with minimal organ toxicity. In this setting, the atypical, centrally acting analgesic tramadol offers important benefits. Its multi-modal effect results from a dual mode of action, ie, opioid and monoaminergic mechanisms, with efficacy in both nociceptive and neuropathic pain. Moreover, fewer instances of side effects such as constipation, respiratory depression, and sedation occur than with traditional opioids, and tramadol has been prescribed for 30 years for a broad range of indications. Tramadol is now regarded as the first-line analgesic for many musculoskeletal indications. In conclusion, it is recommended to better implement the more recent guidelines focusing on pain management and consider the role of tramadol in musculoskeletal pain treatment strategies. PMID:18472996

  12. Current therapeutic vaccination and immunotherapy strategies for HPV-related diseases.

    Science.gov (United States)

    Skeate, Joseph G; Woodham, Andrew W; Einstein, Mark H; Da Silva, Diane M; Kast, W Martin

    2016-06-02

    Carcinomas of the anogenital tract, in particular cervical cancer, remains one of the most common cancers in women, and represent the most frequent gynecological malignancies and the fourth leading cause of cancer death in women worldwide. Human papillomavirus (HPV)-induced lesions are immunologically distinct in that they express viral antigens, which are necessary to maintain the cancerous phenotype. The causal relationship between HPV infection and anogenital cancer has prompted substantial interest in the development of therapeutic vaccines against high-risk HPV types targeting the viral oncoproteins E6 and E7. This review will focus on the most recent clinical trials for immunotherapies for mucosal HPV-induced lesions as well as emerging therapeutic strategies that have been tested in pre-clinical models for HPV-induced diseases. Progress in peptide- and protein-based vaccines, DNA-based vaccines, viral/bacterial vector-based vaccines, immune checkpoint inhibition, immune response modifiers, and adoptive cell therapy for HPV will be discussed.

  13. [Current strategies to diminish the impact of cardiovascular diseases in women].

    Science.gov (United States)

    Stramba Badiale, Marco; Priori, Silvia G

    2006-11-01

    The European Society of Cardiology (ESC) has recently promoted the "Women at Heart" program in order to organize initiatives targeted at promoting research and education in the field of cardiovascular diseases in women. Comparisons of the gender differences in specific disease and treatment trends across Europe are provided by analyzing data from the Euro Heart Surveys. A Policy Conference has been organized with the objective to summarize the state of the art from an European perspective, to identify the scientific gaps and to delineate the strategies for changing the misperception of cardiovascular diseases in women, improving risk stratification, diagnosis, and therapy from a gender perspective and increasing women representation in clinical trials. A Statement from the Policy Conference has been provided and published in the European Heart Journal. Synergic activities should be undertaken at European level with the support of national scientific societies, European institutions, national health care authorities, patients' associations, and foundations. The commitment of the Board of the ESC is that these initiatives contribute to increase the awareness across Europe that cardiovascular disease is the primary cause of death in women and to improve the knowledge of risk factors, presentation and treatment of cardiovascular diseases in women.

  14. In utero hematopoietic stem cell transfer: current status and future strategies.

    Science.gov (United States)

    Surbek, D V; Gratwohl, A; Holzgreve, W

    1999-07-01

    Successful prenatal treatment of severe immunodeficiencies by allogeneic hematopoietic stem cell transplantation in utero has been reported. Though other diseases like hemoglobinopathies or storage diseases are potentially amenable to this novel therapeutic approach, no success has yet been achieved in recipients without severe immunodeficiency. Graft rejection by the developing fetus and/or lack of selective, competitive advantage of donor versus host stem cells preventing stable engraftment seem to be the major obstacles. Several strategies to overcome these hurdles are being explored in preclinical settings, including timing and repeated dosing of stem cell administration to the fetus, ex vivo modification of the transplant, using different fetal compartments as targets for early stem cell transfer, or inducing microchimerism for postnatal transplantation from the same donor. In addition, the exact definition of the basic concept of early fetal immunologic naivete and the understanding of the molecular basics of migration and homing in fetal hematopoiesis system seem mandatory for a successful approach. Gene therapy using ex vivo transduced autologous cord blood cells or direct gene targeting in utero are other potential means to correct hematopoietic and immunologic single gene disorders in utero, though this approach is still away from the stage of clinical trials.

  15. The Impact of Trampling on Reef Macrobenthos in Northeastern Brazil: How Effective are Current Conservation Strategies?

    Science.gov (United States)

    Santos, Gleice S.; Burgos, Douglas C.; Lira, Simone M. A.; Schwamborn, Ralf

    2015-10-01

    Tropical reefs are used for intensive tourism in various parts of the world. However, few studies have investigated the effect of regular trampling on these fragile ecosystems. The aim of this study was to assess the effect of different conservation strategies (open access, partial protection, and total long-term closure) on intertidal reef tops in Porto de Galinhas and Tamandaré, Pernambuco State, Brazil. Analysis of the macrobenthic community was performed with photo transects and image analysis (CPCe). Twenty-seven transects were surveyed from January to August 2012, in intensively impacted (I) open-access sites, in partially protected (P) sites with occasional, illegal trampling, and in a permanently closed (C) site. In I sites, total live cover was half the cover found in adjacent P sites. The area of bare rock averaged 53.6 and 25.0 % in I and P sites, respectively. In the C site, the area of bare rock was only 19.8 %. In I and P sites, macroalgae ( Palisada perforata) were dominating, while in the C site, the zoanthid Zoanthus sociatus was most abundant. Shell-bearing vermetids ( Petaloconchus varians) and bivalves ( Isognomon bicolor) were more abundant at the C site, being possible bioindicators for areas with zero or little trampling. Twelve years of total closure produced near-pristine communities in the C site, dominated by zoanthids and fragile mollusks. This study showed that trampling has severe and long-lasting consequences for the structure of these ecosystems.

  16. [Predictors of the use of the early invasive strategy in women with non-ST-elevation acute coronary syndrome].

    Science.gov (United States)

    de Miguel-Balsa, E; Baeza-Román, A; Pino-Izquierdo, K; Latour-Pérez, J; Coves-Orts, F J; Alcoverro-Pedrola, J M; Pavía-Pesquera, M C; Felices-Abad, F; Calvo-Embuena, R

    2014-11-01

    To identify determinants associated to an early invasive strategy in women with acute coronary syndromes without ST elevation (NSTE-ACS). A retrospective cohort study was made. Crude and adjusted analysis of the performance of the early invasive strategy using logistic regression. Coronary Units enrolled in 2010 - 2011 in the ARIAM-SEMICYUC registry. A total of 440 women with NSTE-ACS were studied. Sixteen patients were excluded due to insufficient data, together with 58 patients subjected to elective coronary angiography (> 72 h). Demographic parameters, coronary risk factors, previous medication, comorbidity. Clinical, laboratory, hemodynamic and electrocardiographic data of the episode. Women treated conservatively were of older age, had oral anticoagulation, diabetes, previous coronary lesions, and heart failure (p 80 years (OR 0.48, 95% CI 0.27 to 0.82, p=0.009), known coronary lesions (OR 0.47, 95% CI 0.26-0.84, p=0.011), and heart rate (OR 0.98, 95% CI 0.97-0.99, p=0.003) were independently associated to conservative treatment. Smoking (OR 2.50, 95% CI 1.20 to 5.19, p=0.013) and high-risk electrocardiogram (OR 2.96, 95% CI 1.72 to 4.97, p 80 years and increased heart rate were independent factors associated to conservative treatment. Copyright © 2012 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  17. Elicitors as alternative strategy to pesticides in grapevine? Current knowledge on their mode of action from controlled conditions to vineyard.

    Science.gov (United States)

    Delaunois, Bertrand; Farace, Giovanni; Jeandet, Philippe; Clément, Christophe; Baillieul, Fabienne; Dorey, Stéphan; Cordelier, Sylvain

    2014-04-01

    Development and optimisation of alternative strategies to reduce the use of classic chemical inputs for protection against diseases in vineyard is becoming a necessity. Among these strategies, one of the most promising consists in the stimulation and/or potentiation of the grapevine defence responses by the means of elicitors. Elicitors are highly diverse molecules both in nature and origins. This review aims at providing an overview of the current knowledge on these molecules and will highlight their potential efficacy from the laboratory in controlled conditions to vineyards. Recent findings and concepts (especially on plant innate immunity) and the new terminology (microbe-associated molecular patterns, effectors, etc.) are also discussed in this context. Other objectives of this review are to highlight the difficulty of transferring elicitors use and results from the controlled conditions to the vineyard, to determine their practical and effective use in viticulture and to propose ideas for improving their efficacy in non-controlled conditions.

  18. An Optimal PR Control Strategy with Load Current Observer for a Three-Phase Voltage Source Inverter

    Directory of Open Access Journals (Sweden)

    Xiaobo Dou

    2015-07-01

    Full Text Available Inverter voltage control is an important task in the operation of a DC/AC microgrid system. To improve the inverter voltage control dynamics, traditional approaches attempt to measure and feedforward the load current, which, however, needs remote measurement with communications in a microgrid system with distributed loads. In this paper, a load current observer (LCO based control strategy, which does not need remote measurement, is proposed for sinusoidal signals tracking control of a three-phase inverter of the microgrid. With LCO, the load current is estimated precisely, acting as the feedforward of the dual-loop control, which can effectively enlarge the stability margin of the control system and improve the dynamic response to load disturbance. Furthermore, multiple PR regulators are applied in this strategy conducted in a stationary  frame to suppress the transient fluctuations and the total harmonic distortion (THD of the output voltage and achieve faster transient performance compared with traditional dual-loop control in a rotating dq0 frame under instantaneous change of various types of load (i.e., balanced load, unbalanced load, and nonlinear load. The parameters of multiple PR regulators are analyzed and selected through the root locus method and the stability of the whole control system is evaluated and analyzed. Finally, the validity of the proposed approach is verified through simulations and a three-phase prototype test system with a TMS320F28335 DSP.

  19. The potential impact of various diagnostic strategies in cases of chronic pain syndromes associated with lumbar spine degeneration

    Directory of Open Access Journals (Sweden)

    Bokov A

    2013-04-01

    Full Text Available Andrey Bokov, Olga Perlmutter, Alexander Aleynik, Marina Rasteryaeva, Sergey Mlyavykh Scientific Research Institute of Traumatology and Orthopedics, Nizhniy Novgorod, Russian Federation Purpose: To study the possible effects of various diagnostic strategies and the relative contribution of various structures in order to determine the optimal diagnostic strategy in treating patients with noncompressive pain syndromes. Study design: Prospective, nonrandomized cohort study of 83 consecutive patients with noncompressive pain syndromes resistant to repeated courses of conservative treatment. The follow-up period was 18 months. Results: Nucleoplasty was effective in cases of discogenic pain; the consequences related to false positive results of the discography were significant. The most specific criterion was 80% pain relief after facet joint blocks, whereas 50% pain relief and any subjective pain relief were not associated with a significant increase in the success rate. A considerable rate of false negative results was associated with 80% pain relief, whereas 50% pain relief after facet joint blocks showed the optimal ratio of sensitivity and specificity. Facet joint pain was detected in 50.6% of cases (95% confidence interval 44.1%–66.3%, discogenic pain in 16.9% cases (95% confidence interval 9.5%–26.7%, and sacroiliac joint pain in 7.2% cases (95% confidence interval 2.7%–15%. It was impossible to differentiate the main source of pain in 25.3% of cases. Conclusion: It is rational to adjust the diagnostic algorithm to the probability of detecting a particular pain source and, in doing so, reduce the number of invasive diagnostic measures to evaluate a pain source. False positive results of diagnostic measures can negatively affect the overall efficacy of a particular technology; therefore, all reasons for the failure should be studied in order to reach an unbiased conclusion. In choosing diagnostic criteria, not only should the success rate

  20. Alternating current electrical stimulation enhanced chemotherapy: a novel strategy to bypass multidrug resistance in tumor cells

    International Nuclear Information System (INIS)

    Janigro, Damir; Perju, Catalin; Fazio, Vincent; Hallene, Kerri; Dini, Gabriele; Agarwal, Mukesh K; Cucullo, Luca

    2006-01-01

    Tumor burden can be pharmacologically controlled by inhibiting cell division and by direct, specific toxicity to the cancerous tissue. Unfortunately, tumors often develop intrinsic pharmacoresistance mediated by specialized drug extrusion mechanisms such as P-glycoprotein. As a consequence, malignant cells may become insensitive to various anti-cancer drugs. Recent studies have shown that low intensity very low frequency electrical stimulation by alternating current (AC) reduces the proliferation of different tumor cell lines by a mechanism affecting potassium channels while at intermediate frequencies interfere with cytoskeletal mechanisms of cell division. The aim of the present study is to test the hypothesis that permeability of several MDR1 over-expressing tumor cell lines to the chemotherapic agent doxorubicin is enhanced by low frequency, low intensity AC stimulation. We grew human and rodent cells (C6, HT-1080, H-1299, SKOV-3 and PC-3) which over-expressed MDR1 in 24-well Petri dishes equipped with an array of stainless steel electrodes connected to a computer via a programmable I/O board. We used a dedicated program to generate and monitor the electrical stimulation protocol. Parallel cultures were exposed for 3 hours to increasing concentrations (1, 2, 4, and 8 μM) of doxorubicin following stimulation to 50 Hz AC (7.5 μA) or MDR1 inhibitor XR9576. Cell viability was assessed by determination of adenylate kinase (AK) release. The relationship between MDR1 expression and the intracellular accumulation of doxorubicin as well as the cellular distribution of MDR1 was investigated by computerized image analysis immunohistochemistry and Western blot techniques. By the use of a variety of tumor cell lines, we show that low frequency, low intensity AC stimulation enhances chemotherapeutic efficacy. This effect was due to an altered expression of intrinsic cellular drug resistance mechanisms. Immunohistochemical, Western blot and fluorescence analysis revealed

  1. Tissue engineered vascular grafts: Origins, development, and current strategies for clinical application.

    Science.gov (United States)

    Benrashid, Ehsan; McCoy, Christopher C; Youngwirth, Linda M; Kim, Jina; Manson, Roberto J; Otto, James C; Lawson, Jeffrey H

    2016-04-15

    Since the development of a dependable and durable synthetic non-autogenous vascular conduit in the mid-twentieth century, the field of vascular surgery has experienced tremendous growth. Concomitant with this growth, development in the field of bioengineering and the development of different tissue engineering techniques have expanded the armamentarium of the surgeon for treating a variety of complex cardiovascular diseases. The recent development of completely tissue engineered vascular conduits that can be implanted for clinical application is a particularly exciting development in this field. With the rapid advances in the field of tissue engineering, the great hope of the surgeon remains that this conduit will function like a true blood vessel with an intact endothelial layer, with the ability to respond to endogenous vasoactive compounds. Eventually, these engineered tissues may have the potential to supplant older organic but not truly biologic technologies, which are used currently. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Prehospital evaluation and economic analysis of different coronary syndrome treatment strategies - PREDICT - Rationale, Development and Implementation

    Directory of Open Access Journals (Sweden)

    Craig Alan

    2011-03-01

    Full Text Available Abstract Background A standard of prehospital care for patients presenting with ST-segment elevation myocardial infarction (STEMI includes prehospital 12-lead and advance Emergency Department notification or prehospital bypass to percutaneous coronary intervention centres. Implementation of either care strategies is variable across communities and neither may exist in some communities. The main objective is to compare prehospital care strategies for time to treatment and survival outcomes as well as cost effectiveness. Methods/Design PREDICT is a multicentre, prospective population-based cohort study of all chest pain patients 18 years or older presenting within 30 mins to 6 hours of symptom onset and treated with nitroglycerin, transported by paramedics in a number of different urban and rural regions in Ontario. The primary objective of this study is to compare the proportion of study subjects who receive reperfusion within the target door-to-reperfusion times in subjects obtained after four prehospital strategies: 12-lead ECG and advance emergency department (ED notification or 3-lead ECG monitoring and alert to dispatch prior to hospital arrival; either with or without the opportunity to bypass to a PCI centre. Discussion We anticipate four challenges to successful study implementation and have developed strategies for each: 1 diversity in the interpretation of the ethical and privacy issues across 47 research ethics boards/commiittees covering 71 hospitals, 2 remote oversight of data guardian abstraction, 3 timeliness of implementation, and 4 potential interference in the study by concurrent technological advances. Research ethics approvals from academic centres were obtained initially and submitted to non academic centre applications. Data guardians were trained by a single investigator and data entry is informed by a detailed data dictionary including variable definitions and abstraction instrucations and subjected to error and logic

  3. Mycotoxin problem in Africa: current status, implications to food safety and health and possible management strategies.

    Science.gov (United States)

    Wagacha, J M; Muthomi, J W

    2008-05-10

    Mycotoxins are toxic secondary metabolites of fungal origin and contaminate agricultural commodities before or under post-harvest conditions. They are mainly produced by fungi in the Aspergillus, Penicillium and Fusarium genera. When ingested, inhaled or absorbed through the skin, mycotoxins will cause lowered performance, sickness or death on humans and animals. Factors that contribute to mycotoxin contamination of food and feed in Africa include environmental, socio-economic and food production. Environmental conditions especially high humidity and temperatures favour fungal proliferation resulting in contamination of food and feed. The socio-economic status of majority of inhabitants of sub-Saharan Africa predisposes them to consumption of mycotoxin contaminated products either directly or at various points in the food chain. The resulting implications include immuno-suppression, impaired growth, various cancers and death depending on the type, period and amount of exposure. A synergistic effect between mycotoxin exposure and some important diseases in the continent such as malaria, kwashiorkor and HIV/AIDS have been suggested. Mycotoxin concerns have grown during the last few decades because of their implications to human and animal health, productivity, economics of their management and trade. This has led to development of maximum tolerated limits for mycotoxins in various countries. Even with the standards in place, the greatest recorded fatal mycotoxin-poisoning outbreak caused by contamination of maize with aflatoxins occurred in Africa in 2004. Pre-harvest practices; time of harvesting; handling of produce during harvesting; moisture levels at harvesting, transportation, marketing and processing; insect damage all contribute to mycotoxin contamination. Possible intervention strategies include good agricultural practices such as early harvesting, proper drying, sanitation, proper storage and insect management among others. Other possible interventions

  4. European Union's strategy on endocrine disrupting chemicals and the current position of Slovenia.

    Science.gov (United States)

    Perharič, Lucija; Fatur, Tanja; Drofenik, Jernej

    2016-06-01

    In view of the European Union regulations 1107/2009 and 528/2012, which say that basic substances in plant protection and biocidal products marketed in the European Union (EU) should not have an inherent capacity to cause endocrine disruption, an initiative was started to define scientific criteria for the identification of endocrine disruptors (EDs). The objectives of the EU strategy on EDs are to protect human health and the environment, to assure the functioning of the market, and to provide clear and coherent criteria for the identification of EDs that could have broad application in the EU legislation. Policy issues were to be addressed by the Ad-hoc group of Commission Services, EU Agencies and Member States established in 2010, whereas the scientific issues were to be addressed by the Endocrine Disruptors Expert Advisory Group (ED EAG), established in 2011. The ED EAG adopted the 2002 World Health Organization (WHO) definition of endocrine disruptor and agreed that for its identification it is necessary to produce convincing evidence of a biologically plausible causal link between an adverse effect and endocrine disrupting mode of action. In 2014, the European Commission proposed four ED identification criteria options and three regulatory options, which are now being assessed for socio-economic, environmental, and health impact. Slovenia supports the establishing of identification criteria and favours option 4, according to which ED identification should be based on the WHO definition with the addition of potency as an element of hazard characterisation. As for regulatory options, Slovenia favours the risk-based rather than hazard-based regulation.

  5. Computationally derived points of fragility of a human cascade are consistent with current therapeutic strategies.

    Directory of Open Access Journals (Sweden)

    Deyan Luan

    2007-07-01

    Full Text Available The role that mechanistic mathematical modeling and systems biology will play in molecular medicine and clinical development remains uncertain. In this study, mathematical modeling and sensitivity analysis were used to explore the working hypothesis that mechanistic models of human cascades, despite model uncertainty, can be computationally screened for points of fragility, and that these sensitive mechanisms could serve as therapeutic targets. We tested our working hypothesis by screening a model of the well-studied coagulation cascade, developed and validated from literature. The predicted sensitive mechanisms were then compared with the treatment literature. The model, composed of 92 proteins and 148 protein-protein interactions, was validated using 21 published datasets generated from two different quiescent in vitro coagulation models. Simulated platelet activation and thrombin generation profiles in the presence and absence of natural anticoagulants were consistent with measured values, with a mean correlation of 0.87 across all trials. Overall state sensitivity coefficients, which measure the robustness or fragility of a given mechanism, were calculated using a Monte Carlo strategy. In the absence of anticoagulants, fluid and surface phase factor X/activated factor X (fX/FXa activity and thrombin-mediated platelet activation were found to be fragile, while fIX/FIXa and fVIII/FVIIIa activation and activity were robust. Both anti-fX/FXa and direct thrombin inhibitors are important classes of anticoagulants; for example, anti-fX/FXa inhibitors have FDA approval for the prevention of venous thromboembolism following surgical intervention and as an initial treatment for deep venous thrombosis and pulmonary embolism. Both in vitro and in vivo experimental evidence is reviewed supporting the prediction that fIX/FIXa activity is robust. When taken together, these results support our working hypothesis that computationally derived points of

  6. Clinical and economic analysis of the modern strategies for treating metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Marina Fedorovna Kalashnikova

    2014-04-01

    Full Text Available Objective. The objective of this study was to identify the ways to optimize therapy for metabolic syndrome through complex clinical and economic analysis. Methods. Sixty patients with metabolic syndrome were included in the study. The study group (30 subjects with the mean age of 41.0?11 years, 23 females (76.7%, 7 males (23.3% received pharmacotherapy for obesity (orlistat and insulin resistance (metformin, lipid-lowering therapy and antihypertensive therapy, if needed. The control group (30 patients with the mean age of 43.4?9.5 years, 26 females (86.7%, 4 males (13.3% received lipid-lowering and antihypertensive therapy, if needed. All patients underwent clinical and laboratory examination, assessment of depression (Beck Depression Inventory and evaluation of the quality of life using the SF-36 questionnaire at admission to the study and after 6 months of therapy. Complex clinical and economic analyses, including cost-effectiveness and cost-utility analyses and calculation of such indices as ?the incremental cost-effectiveness ratio? (ICER, LYG, QALY and ?net monetary benefit? (NMB, were conducted based on the results obtained. Results. Improvement of clinical and laboratory indicators and quality of life in the study group was more significant than that in the control group. The direct medical costs were 33,440.40 RUB for the study group and 18,878.50 RUB for the control group (for 6 months of therapy. The control group CER was 4,016.70, while the study group CER was 3,125.30; ICER was 2,430.90 RUB. LYG was equal to 0.7 and 2.3 years for the control and the study groups, respectively. The QALY measure for the control and study groups was 8.63 and 9.45, respectively. The weighted average total costs for the intended period of living was 498,745.00 RUB for the control group and 457,866.00 RUB for the study group. The control group CUR was 57,792.00 and 54,902.00 RUB/QALY without and with discounting, respectively, while in the study group they

  7. Clinical and economic analysis of the modern strategies for treating metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Marina Fedorovna Kalashnikova

    2014-04-01

    Full Text Available ObjectiveThe objective of this study was to identify the ways to optimize therapy for metabolic syndrome through complex clinical and economic analysis.MethodsSixty patients with metabolic syndrome were included in the study. The study group (30 subjects with the mean age of 41.0±11 years, 23 females (76.7%, 7 males (23.3% received pharmacotherapy for obesity (orlistat and insulin resistance (metformin, lipid-lowering therapy and antihypertensive therapy, if needed. The control group (30 patients with the mean age of 43.4±9.5 years, 26 females (86.7%, 4 males (13.3% received lipid-lowering and antihypertensive therapy, if needed. All patients underwent clinical and laboratory examination, assessment of depression (Beck Depression Inventory and evaluation of the quality of life using the SF-36 questionnaire at admission to the study and after 6 months of therapy. Complex clinical and economic analyses, including cost-effectiveness and cost-utility analyses and calculation of such indices as “the incremental cost-effectiveness ratio” (ICER, LYG, QALY and “net monetary benefit” (NMB, were conducted based on the results obtained.ResultsImprovement of clinical and laboratory indicators and quality of life in the study group was more significant than that in the control group. The direct medical costs were 33,440.40 RUB for the study group and 18,878.50 RUB for the control group (for 6 months of therapy. The control group CER was 4,016.70, while the study group CER was 3,125.30; ICER was 2,430.90 RUB. LYG was equal to 0.7 and 2.3 years for the control and the study groups, respectively. The QALY measure for the control and study groups was 8.63 and 9.45, respectively. The weighted average total costs for the intended period of living was 498,745.00 RUB for the control group and 457,866.00 RUB for the study group. The control group CUR was 57,792.00 and 54,902.00 RUB/QALY without and with discounting, respectively, while in the study group

  8. Current evidence for effectiveness of interventions for cubital tunnel syndrome, radial tunnel syndrome, instability, or bursitis of the elbow: a systematic review.

    Science.gov (United States)

    Rinkel, Willem D; Schreuders, Ton A R; Koes, Bart W; Huisstede, Bionka M A

    2013-12-01

    To provide an evidence-based overview of the effectiveness of interventions for 4 nontraumatic painful disorders sharing the anatomic region of the elbow: cubital tunnel syndrome, radial tunnel syndrome, elbow instability, and olecranon bursitis. The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched to identify relevant reviews and randomized clinical trials (RCTs). Two reviewers independently extracted data and assessed the quality of the methodology. A best-evidence synthesis was used to summarize the results. One systematic review and 6 RCTs were included. For the surgical treatment of cubital tunnel syndrome (1 review, 3 RCTs), comparing simple decompression with anterior ulnar nerve transposition, no evidence was found in favor of either one of these. Limited evidence was found in favor of medial epicondylectomy versus anterior transposition and for early postoperative therapy versus immobilization. No evidence was found for the effect of local steroid injection in addition to splinting. No RCTs were found for radial tunnel syndrome. For olecranon bursitis (1 RCT), limited evidence for effectiveness was found for methylprednisolone acetate injection plus naproxen. Concerning elbow instability, including 2 RCTs, one showed that nonsurgical treatment resulted in similar results compared with surgery, whereas the other found limited evidence for the effectiveness in favor of early mobilization versus 3 weeks of immobilization after surgery. In this review no, or at best, limited evidence was found for the effectiveness of nonsurgical and surgical interventions to treat painful cubital tunnel syndrome, radial tunnel syndrome, elbow instability, or olecranon bursitis. Well-designed and well-conducted RCTs are clearly needed in this field.

  9. The relationship between coping strategies and burnout syndrome in oncology nurses

    Directory of Open Access Journals (Sweden)

    Šárka Vévodová

    2016-01-01

    Full Text Available Stress is a major problem in the nursing profession. It is related to work overload, lack of nursing staff, and work in shifts, lack of coping strategies and a high turnover amongst health care staff. Rapid increase of stress in the oncology centers results in a high risk of burnout. One of the options for prevention is to find suitable coping strategies. The research objective of this study was to determine the rate of burnout amongst oncology nurses and to determine the relationship between coping strategies and burnout amongst oncology nurses in the Czech Republic. The survey was designed as a quantitative research. A questionnaire battery was used consisting of questionnaires MBI-GS (Maslach Burnout Inventory-General Survey, evaluating the degree of burnout (emotional exhaustion, depersonalization and personal accomplishment and standardized questionnaire OSI-R (Inventory of occupational stress which evaluates the emotional, cognitive stress management and the coping strategy (personal resources for coping with stress. The results of a questionnaire MBI-GS showed that out of the total of 140 oncology nurses, burnout was detected in 36 (26 % in the area of emotional exhaustion, in 24 (17 % in depersonalization, and in 53 nurses (28 % in personal accomplishment. The existence of a significant negative relationship was confirmed between the extent of burnout and all coping strategies monitored - social support, relaxation, self-care, and rational / cognitive coping.When analyzing all three areas of burnout, 23.66 % from the total number of 140 nurses are in the state of burnout. The results can be compared with the results of studies conducted by Zálešáková, Bužgová (2011 who found alarming values of burnout among 36.9 % oncology nurses and 11.9 % of the nurses were in the state of burnout. A meta-analysis of studies focusing on burnout among health care professionals working in oncology indicated that 25-36 % showed signs of burnout

  10. Do Coffee Polyphenols Have a Preventive Action on Metabolic Syndrome Associated Endothelial Dysfunctions? An Assessment of the Current Evidence.

    Science.gov (United States)

    Yamagata, Kazuo

    2018-02-04

    Epidemiologic studies from several countries have found that mortality rates associated with the metabolic syndrome are inversely associated with coffee consumption. Metabolic syndrome can lead to arteriosclerosis by endothelial dysfunction, and increases the risk for myocardial and cerebral infarction. Accordingly, it is important to understand the possible protective effects of coffee against components of the metabolic syndrome, including vascular endothelial function impairment, obesity and diabetes. Coffee contains many components, including caffeine, chlorogenic acid, diterpenes and trigonelline. Studies have found that coffee polyphenols, such as chlorogenic acids, have many health-promoting properties, such as antioxidant, anti-inflammatory, anti-cancer, anti-diabetes, and antihypertensive properties. Chlorogenic acids may exert protective effects against metabolic syndrome risk through their antioxidant properties, in particular toward vascular endothelial cells, in which nitric oxide production may be enhanced, by promoting endothelial nitric oxide synthase expression. These effects indicate that coffee components may support the maintenance of normal endothelial function and play an important role in the prevention of metabolic syndrome. However, results related to coffee consumption and the metabolic syndrome are heterogeneous among studies, and the mechanisms of its functions and corresponding molecular targets remain largely elusive. This review describes the results of studies exploring the putative effects of coffee components, especially in protecting vascular endothelial function and preventing metabolic syndrome.

  11. Do Coffee Polyphenols Have a Preventive Action on Metabolic Syndrome Associated Endothelial Dysfunctions? An Assessment of the Current Evidence

    Science.gov (United States)

    Yamagata, Kazuo

    2018-01-01

    Epidemiologic studies from several countries have found that mortality rates associated with the metabolic syndrome are inversely associated with coffee consumption. Metabolic syndrome can lead to arteriosclerosis by endothelial dysfunction, and increases the risk for myocardial and cerebral infarction. Accordingly, it is important to understand the possible protective effects of coffee against components of the metabolic syndrome, including vascular endothelial function impairment, obesity and diabetes. Coffee contains many components, including caffeine, chlorogenic acid, diterpenes and trigonelline. Studies have found that coffee polyphenols, such as chlorogenic acids, have many health-promoting properties, such as antioxidant, anti-inflammatory, anti-cancer, anti-diabetes, and antihypertensive properties. Chlorogenic acids may exert protective effects against metabolic syndrome risk through their antioxidant properties, in particular toward vascular endothelial cells, in which nitric oxide production may be enhanced, by promoting endothelial nitric oxide synthase expression. These effects indicate that coffee components may support the maintenance of normal endothelial function and play an important role in the prevention of metabolic syndrome. However, results related to coffee consumption and the metabolic syndrome are heterogeneous among studies, and the mechanisms of its functions and corresponding molecular targets remain largely elusive. This review describes the results of studies exploring the putative effects of coffee components, especially in protecting vascular endothelial function and preventing metabolic syndrome. PMID:29401716

  12. [Current prevention and treatment strategies for osteoporosis. Fracture-oriented, effective, low side effects and inexpensive].

    Science.gov (United States)

    Bartl, R; Bartl, C

    2015-12-01

    Osteoporosis is still an underdiagnosed and insufficiently therapied widespread disease in Germany. Of the estimated 7 million osteoporosis patients only 1.5 million receive a guideline conform diagnosis and even less receive appropriate treatment. Some 90 % of patients are provided with analgesics but only 10 % receive an effective therapy, although efficacious, well-tested and affordable medications are available. In addition, approximately one half of the patients terminate treatment after only 1 year although according to the results of recent studies the duration of therapy should be at least 3-5 years. In view of the increasing average life expectancy, a consistent management for prevention of fractures associated with osteoporosis is always most important for society, even if only for reasons of costs. Achievement of this target depends on four circumstances: clarification of the origin of osteoporosis and fractures (bone consciousness), prophylaxis of bone loss and fractures (primary prevention), consistent guideline conform diagnostics and therapy (secondary and tertiary prevention) and cooperation of all disciplines in medicine (bone is everybody's business). This article describes the current state of diagnostics (bone density measurement with dual X-ray absorptiometry, FRAX®), prophylaxis of fractures (screening program) and therapy (use of economic and effective medications with low side effects). Novel medications are already undergoing clinical testing and a "healing" of bone reduction with restoration of the normal bone structure is to be expected.

  13. A study on current status of KAERI's international cooperation programs and strategies for effective implementation

    International Nuclear Information System (INIS)

    Kim, Kyoung Pyo; Park, Chun Kab; Noh, In Young; Kim, Young Min

    1998-12-01

    This is a report on the status and analysis of standard agreement for technical cooperation, expert mission service and technical staff attachment. This report comprises a total of six chapters. Chapter II discusses the status of the technical cooperation agreement which took effect late 1998, and various other model agreements for technical cooperation. Chapter III provides information on the status, regulations, procedures for the expert mission service, and Chapter IV details the current status of the technical staff attachment and the related procedures. Chapter V deals with the utilization status and analysis of the English Counselor, and Chapter VI is the Conclusion. This report has tow objectives. First, we have never published reference books related to standard agreement for technical cooperation, expert mission service and technical staff attachment necessary for international joint research until now. As a result, the research divisions have often asked many questions to the office of international cooperation. Therefore, we expect that many difficulties will be removed and procedures simplified if the research divisions use this report as a reference book. Second, we plan to use this report reference book for policy decisions after establishing the database. (author). 5 tabs., 9 figs

  14. Current and future strategy for breast cancer treatment at Nagasaki University Hospital

    International Nuclear Information System (INIS)

    Morishita, Mariko; Hayashi, Tomayoshi; Maeda, Shigeto

    2005-01-01

    Breast cancer has emerged as the most frequent malignant neoplasm among Japanese women in recent years, raising awareness in society of the issue of breast cancer, including good screening and therapies. In fact, the establishment of breast cancer screening program with mammography in the United States and Western Europe has contributed to improve the diagnosis of breast cancer at early stage, and proper management, including various options of evidence-based treatment has not only reduced mortality but also enhanced patients' quality of life. However, the mortality rate due to breast cancer in Japan has continued to increase, and the number of patients is also increasing rapidly. It is therefore very urgent to develop a good system of breast care in all medical facilities as well as the provision of a national scheme in Japan. In this report, we review the situations of breast surgery at Nagasaki University Hospital from 1975 to 2004 and current management practices for breast disease, and evaluate the possibility of establishing a better system for breast care at our hospital, which could then act as a core medical institute in Nagasaki. (author)

  15. A review of current strategy for rabies prevention and control in the developing world

    Directory of Open Access Journals (Sweden)

    Suneela Garg

    2017-03-01

    Full Text Available The control of Rabies, a zoonotic viral disease is a major public challenge in several developing countries. Current approaches for rabies control are overwhelmingly directed towards provision of effective post exposure prophylaxis (PEP to animal bite victims. The enormous costs involved in rabies prophylaxis is an important factor precluding its universal application in all animal bite victims especially in those residing in resource constrained settings. The intradermal route of administration has been shown to be cost effective except in peripheral regions with fewer animal bite cases. Nevertheless, rabies control program with their expected emphasis on human rabies prophylaxis have neglected canine vaccination. The feasibility of canine rabies vaccination depends primarily upon allocation of resources through political commitment and effective public private partnerships. However, in large parts of the world including India formal dog ownership constitutes a small minority of the overall canine population while state funded canine vaccination drives often fail to impress policy makers who struggle to maintain budgets for adequate coverage of rabies PEP for animal bite victims. The key to rabies control may therefore rest upon a one health approach with development of newer vaccine technology which is cost effective for vaccination in both, man and animal.

  16. Organ Preservation: Current Concepts and New Strategies for the Next Decade

    Science.gov (United States)

    Guibert, Edgardo E.; Petrenko, Alexander Y.; Balaban, Cecilia L.; Somov, Alexander Y.; Rodriguez, Joaquín V.; Fuller, Barry J.

    2011-01-01

    Summary Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years. PMID:21566713

  17. CURRENT SITUATION OF CIVIL AWARENESS OF UNDERGRADUATE AND PROMOTION STRATEGY RESEARCH

    Directory of Open Access Journals (Sweden)

    Li Hong-Mei

    2017-06-01

    Full Text Available We conducted on a questionnaire survey for the current college students’ civic awareness from four aspects of equality consciousness, national consciousness, freedom consciousness and public consciousness. Survey data was analyzed with the SAS® statistical software, the results shown that some of our country’s College Students with a strong national consciousness, and their patriotic feeling is deep at present. They identity the consciousness of equality, but their awareness of fighting for rights is not strong. They have a sense of freedom, but some students are not clear about the relationship between freedom and law. Their enthusiasm to participate in public affairs is not high. Their awareness of social morality is not comprehensive. The reason is that the influence of traditional culture and the political development can’t keep up with the development of economy and the systematic citizenship education is lacked. Finally, we put forward a method of improve the civic awareness of Contemporary College Students in this paper.

  18. Current supply/demand outlook and its impact on gas marketing strategies

    International Nuclear Information System (INIS)

    Maffitt, D.

    1994-01-01

    The current supply/demand outlook for natural gas in Canada is discussed, starting with a review of natural gas supply trends since the deregulation of the market in 1985/86. Market demand trends and expansion of export pipeline capacity are summarized to demonstrate how radically the North American gas marketing industry has changed in the last decade. As of January 1st 1993, Canada ranked eleventh in the world with respect to remaining natural gas reserves (96 Tft 3 ), which represents only 2% of global gas reserves. Canada ranks third in gas production (5 Tft 3 /y), behind the USA and former Soviet Union (19 and 29 Tft 3 /y, respectively). In western Canada, gas production rates have increased 75% since deregulation. Canadian domestic demand has grown 24% since 1985 to the 1993 level of 2.1 Tft 3 /y, while exports to the USA have grown 144% to 2.2 Tft 3 /y. The present environment requires a 'just in time' attitude towards developing new gas reserves and arranging transportation and storage. Long term gas marketing transacations are increasingly deliverability-based, firm delivery commitments which include harsh penalties for nonperformance. 7 figs

  19. Herd Immunity to Ebolaviruses Is Not a Realistic Target for Current Vaccination Strategies

    Directory of Open Access Journals (Sweden)

    Stuart G. Masterson

    2018-05-01

    Full Text Available The recent West African Ebola virus pandemic, which affected >28,000 individuals increased interest in anti-Ebolavirus vaccination programs. Here, we systematically analyzed the requirements for a prophylactic vaccination program based on the basic reproductive number (R0, i.e., the number of secondary cases that result from an individual infection. Published R0 values were determined by systematic literature research and ranged from 0.37 to 20. R0s ≥ 4 realistically reflected the critical early outbreak phases and superspreading events. Based on the R0, the herd immunity threshold (Ic was calculated using the equation Ic = 1 − (1/R0. The critical vaccination coverage (Vc needed to provide herd immunity was determined by including the vaccine effectiveness (E using the equation Vc = Ic/E. At an R0 of 4, the Ic is 75% and at an E of 90%, more than 80% of a population need to be vaccinated to establish herd immunity. Such vaccination rates are currently unrealistic because of resistance against vaccinations, financial/logistical challenges, and a lack of vaccines that provide long-term protection against all human-pathogenic Ebolaviruses. Hence, outbreak management will for the foreseeable future depend on surveillance and case isolation. Clinical vaccine candidates are only available for Ebola viruses. Their use will need to be focused on health-care workers, potentially in combination with ring vaccination approaches.

  20. Human taeniasis: current insights into prevention and management strategies in endemic countries

    Science.gov (United States)

    Okello, Anna L; Thomas, Lian Francesca

    2017-01-01

    Human taeniasis is a zoonotic condition resulting from infection with the adult stages of Taenia saginata (“beef tapeworm”), Taenia solium (“pork tapeworm”) or Taenia asiatica (“Asian tapeworm”). Although these parasites have a worldwide distribution, the overwhelming burden is felt by communities in low- and middle-income countries. This is particularly true for T. solium, whereby infection of the central nervous system with the larval stage of the parasite (neurocysticercosis) is a major cause of acquired epilepsy in low-resource settings. With a focus on endemic countries, this review provides an insight into the prevention and management of human taeniasis, concluding with some recent case studies describing their implementation. Discussion of the opportunities and challenges regarding current fecal and serological diagnostic assays for detecting Taenia spp. highlights the importance of accurate and accessible diagnostic options for the field situation. The lack of long-term impact on the parasites’ lifecycle from human anthelmintic treatment, coupled with the propensity for adverse reactions, highlights the importance of a “two-pronged” approach that considers the relevant animal hosts, particularly in the case of T. solium. Aside from the therapeutic options, this review reiterates the importance of adequate assessment and consideration of the associated behavioral and policy aspects around sanitation, hygiene and meat inspection that have been shown to support parasite control, and potential elimination, in endemic regions. PMID:28615981

  1. Advanced cardiovascular imaging in Williams syndrome: Abnormalities, usefulness, and strategy for use.

    Science.gov (United States)

    Hills, Jordan A; Zarate, Yuri A; Danylchuk, Noelle R; Lepard, Tiffany; Chen, Jean Chi-Jen; Collins, Ronnie Thomas

    2017-05-01

    Extracardiac arterial stenoses are not uncommon in Williams syndrome (WS); however, data on the utility of advanced cardiovascular imaging (CVI) to assess these stenoses are lacking. We retrospectively reviewed the frequency, indication, and diagnostic outcomes of CVI modalities performed in patients with WS evaluated at a single institution between 2001 and 2014. Data were collected and analyzed from 34 patients (56% female) who underwent CVI during the study period. The median age was 10 years (range 1.8-33 years). Excluding echocardiograms, 78 CVI studies "advanced" were performed in the 34 patients (mean 2.3 studies/patient). The most common advanced CVI was renal ultrasound with Doppler (29/34, 85%), followed by computed tomographic angiography (13/34, 38%) and magnetic resonance angiography in (9/34, 26%). Abnormalities were detected in 62% of patients (21/34). For the 20 patients in whom advanced CVI were performed for defined clinical indications, the rate of abnormalities were 73, 70, 57, and 100% when performed for anatomic delineation (15 patients), hypertension (10 patients), bruits (7 patients), and/or decreased peripheral pulses (2 patients), respectively. Advanced CVI in patients with WS reveals abnormalities in the majority of cases, and physical exam findings frequently indicate abnormalities on advanced CVI. © 2017 Wiley Periodicals, Inc.

  2. Cell-Type-Specific Translation Profiling Reveals a Novel Strategy for Treating Fragile X Syndrome.

    Science.gov (United States)

    Thomson, Sophie R; Seo, Sang S; Barnes, Stephanie A; Louros, Susana R; Muscas, Melania; Dando, Owen; Kirby, Caoimhe; Wyllie, David J A; Hardingham, Giles E; Kind, Peter C; Osterweil, Emily K

    2017-08-02

    Excessive mRNA translation downstream of group I metabotropic glutamate receptors (mGlu 1/5 ) is a core pathophysiology of fragile X syndrome (FX); however, the differentially translating mRNAs that contribute to altered neural function are not known. We used translating ribosome affinity purification (TRAP) and RNA-seq to identify mistranslating mRNAs in CA1 pyramidal neurons of the FX mouse model (Fmr1 -/y ) hippocampus, which exhibit exaggerated mGlu 1/5 -induced long-term synaptic depression (LTD). In these neurons, we find that the Chrm4 transcript encoding muscarinic acetylcholine receptor 4 (M 4 ) is excessively translated, and synthesis of M 4 downstream of mGlu 5 activation is mimicked and occluded. Surprisingly, enhancement rather than inhibition of M 4 activity normalizes core phenotypes in the Fmr1 -/y , including excessive protein synthesis, exaggerated mGluR-LTD, and audiogenic seizures. These results suggest that not all excessively translated mRNAs in the Fmr1 -/y brain are detrimental, and some may be candidates for enhancement to correct pathological changes in the FX brain. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  3. Association of Mismatch Repair Mutation With Age at Cancer Onset in Lynch Syndrome: Implications for Stratified Surveillance Strategies.

    Science.gov (United States)

    Ryan, Neil A J; Morris, Julie; Green, Kate; Lalloo, Fiona; Woodward, Emma R; Hill, James; Crosbie, Emma J; Evans, D Gareth

    2017-12-01

    Lynch syndrome is caused by dominantly inherited germline mutations that predispose individuals to colorectal, endometrial, ovarian, and other cancers through inactivation of the cellular mismatch repair system. Lynch syndrome–associated cancers are amenable to surveillance strategies that may improve survival. The age at which surveillance should start is disputed. To determine whether mutated gene and type of mutation influence age at onset of Lynch syndrome–associated cancers. A retrospective cohort study of individuals with Lynch syndrome–associated colorectal, endometrial, and/or ovarian cancers whose medical records were included in the clinical database of a large quaternary referral center for genomic medicine in the Northwest of England. Mutated gene (MLH1, MSH2, MSH6, and/or PMS2) and type of mutation (truncating, splicing, or large rearrangement). Age at cancer diagnosis. A total of 1063 individuals with proven Lynch syndrome were included, 495 male and 568 female (mean age 52 years; age range, 10-93 years [children were included in the database, but no children developed cancer]). There were 546 men and women with colorectal cancer, 162 women with endometrial cancer, and 49 women with ovarian cancer; mean follow-up was 68.2 months. Among MLH1 mutation carriers, mutations in MLH1 were associated with colorectal cancer in 249 (61%) of 409 men and women; endometrial cancer in 53 of 196 (27%) women; and ovarian cancer in 15 (8%) of 196 women. Among MSH2 mutation carriers, mutations in MSH2 (the most prevalent mutations overall) were most commonly associated with female-specific cancers: endometrial cancer in 83 (30%) of 279 women; ovarian cancer in 28 (10%) of 279 women; and colorectal cancer in 239 (50%) 479 men and women. Mutations in MSH6 were less prevalent, and MSH6 mutation carriers presented with colorectal and endometrial cancer at later ages than carriers of mutations in MSH2 or MLH1. When stratified by mutation type, women with truncating

  4. Analysis of metabolomic data: tools, current strategies and future challenges for omics data integration.

    Science.gov (United States)

    Cambiaghi, Alice; Ferrario, Manuela; Masseroli, Marco

    2017-05-01

    Metabolomics is a rapidly growing field consisting of the analysis of a large number of metabolites at a system scale. The two major goals of metabolomics are the identification of the metabolites characterizing each organism state and the measurement of their dynamics under different situations (e.g. pathological conditions, environmental factors). Knowledge about metabolites is crucial for the understanding of most cellular phenomena, but this information alone is not sufficient to gain a comprehensive view of all the biological processes involved. Integrated approaches combining metabolomics with transcriptomics and proteomics are thus required to obtain much deeper insights than any of these techniques alone. Although this information is available, multilevel integration of different 'omics' data is still a challenge. The handling, processing, analysis and integration of these data require specialized mathematical, statistical and bioinformatics tools, and several technical problems hampering a rapid progress in the field exist. Here, we review four main tools for number of users or provided features (MetaCoreTM, MetaboAnalyst, InCroMAP and 3Omics) out of the several available for metabolomic data analysis and integration with other 'omics' data, highlighting their strong and weak aspects; a number of related issues affecting data analysis and integration are also identified and discussed. Overall, we provide an objective description of how some of the main currently available software packages work, which may help the experimental practitioner in the choice of a robust pipeline for metabolomic data analysis and integration. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Engineered skeletal muscle tissue for soft robotics: fabrication strategies, current applications, and future challenges.

    Science.gov (United States)

    Duffy, Rebecca M; Feinberg, Adam W

    2014-01-01

    Skeletal muscle is a scalable actuator system used throughout nature from the millimeter to meter length scales and over a wide range of frequencies and force regimes. This adaptability has spurred interest in using engineered skeletal muscle to power soft robotics devices and in biotechnology and medical applications. However, the challenges to doing this are similar to those facing the tissue engineering and regenerative medicine fields; specifically, how do we translate our understanding of myogenesis in vivo to the engineering of muscle constructs in vitro to achieve functional integration with devices. To do this researchers are developing a number of ways to engineer the cellular microenvironment to guide skeletal muscle tissue formation. This includes understanding the role of substrate stiffness and the mechanical environment, engineering the spatial organization of biochemical and physical cues to guide muscle alignment, and developing bioreactors for mechanical and electrical conditioning. Examples of engineered skeletal muscle that can potentially be used in soft robotics include 2D cantilever-based skeletal muscle actuators and 3D skeletal muscle tissues engineered using scaffolds or directed self-organization. Integration into devices has led to basic muscle-powered devices such as grippers and pumps as well as more sophisticated muscle-powered soft robots that walk and swim. Looking forward, current, and future challenges include identifying the best source of muscle precursor cells to expand and differentiate into myotubes, replacing cardiomyocytes with skeletal muscle tissue as the bio-actuator of choice for soft robots, and vascularization and innervation to enable control and nourishment of larger muscle tissue constructs. © 2013 Wiley Periodicals, Inc.

  6. Human taeniasis: current insights into prevention and management strategies in endemic countries

    Directory of Open Access Journals (Sweden)

    Okello A

    2017-06-01

    Full Text Available Anna L Okello,1 Lian Francesca Thomas2 1Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences College of Medicine and Veterinary Medicine, University of Edinburgh, Scotland; 2Independent Consultant, Lusaka, Zambia Abstract: Human taeniasis is a zoonotic condition resulting from infection with the adult stages of Taenia saginata (“beef tapeworm”, Taenia solium (“pork tapeworm” or Taenia asiatica (“Asian tapeworm”. Although these parasites have a worldwide distribution, the overwhelming burden is felt by communities in low- and middle-income countries. This is particularly true for T. solium, whereby infection of the central nervous system with the larval stage of the parasite (neurocysticercosis is a major cause of acquired epilepsy in low-resource settings. With a focus on endemic countries, this review provides an insight into the prevention and management of human taeniasis, concluding with some recent case studies describing their implementation. Discussion of the opportunities and challenges regarding current fecal and serological diagnostic assays for detecting Taenia spp. highlights the importance of accurate and accessible diagnostic options for the field situation. The lack of long-term impact on the parasites’ lifecycle from human anthelmintic treatment, coupled with the propensity for adverse reactions, highlights the importance of a “two-pronged” approach that considers the relevant animal hosts, particularly in the case of T. solium. Aside from the therapeutic options, this review reiterates the importance of adequate assessment and consideration of the associated behavioral and policy aspects around sanitation, hygiene and meat inspection that have been shown to support parasite control, and potential elimination, in endemic regions. Keywords: Taenia solium, Taenia saginata, cysticercosis, zoonotic disease, neglected tropical diseases

  7. Neuropsychological phenotype and psychopathology in seven adult patients with Phelan-McDermid syndrome : implications for treatment strategy

    NARCIS (Netherlands)

    Egger, J. I. M.; Zwanenburg, R. J.; van Ravenswaaij-Arts, C. M. A.; Kleefstra, T.; Verhoeven, W. M. A.

    Phelan-McDermid syndrome presents with specific deficits in neurocognition, cerebellar regulatory functioning and enhanced vulnerability for the development of atypical bipolar disorder. Phelan-McDermid syndrome (PMS) or 22q13.3 deletion syndrome is characterized by a variable degree of intellectual

  8. Changing paradigms in cranio-facial regeneration: current and new strategies for the activation of endogenous stem cells

    Directory of Open Access Journals (Sweden)

    Luigi eMele

    2016-02-01

    Full Text Available Craniofacial area represent a unique district of human body characterized by a very high complexity of tissues, innervation and vascularization, and being deputed to many fundamental function such as eating, speech, expression of emotions, delivery of sensations such as taste, sight and earing. For this reasons, tissue loss in this area following trauma or for example oncologic resection, have a tremendous impact on patients’ quality of life. In the last 20 years regenerative medicine has emerged as one of the most promising approach to solve problem related to trauma, tissue loss, organ failure etc. One of the most powerful tools to be used for tissue regeneration is represented by stem cells, which have been successfully implanted in different tissue/organs with exciting results. Nevertheless both autologous and allogeneic stem cell transplantation raise many practical and ethical concerns that make this approach very difficult to apply in clinical practice. For this reason different cell free approaches have been developed aiming to the mobilization, recruitment and activation of endogenous stem cells into the injury site avoiding exogenous cells implant but instead stimulating patients’ own stem cells to repair the lesion. To this aim many strategies have been used including functionalized bioscaffold, controlled release of stem cell chemoattractants, growth factors, BMPs, Platelet–Rich-Plasma and other new strategies such as ultrasound wave and laser are just being proposed. Here we review all the current and new strategies used for activation and mobilization of endogenous stem cells in the regeneration of craniofacial tissue.

  9. Current Genetic and Demographic Findings in Down's Syndrome: How Are They Presented in College Textbooks on Exceptionality?

    Science.gov (United States)

    Abroms, Kippy I.; Bennett, J. W.

    1980-01-01

    A survey of 39 recent college textbooks in mental retardation, special education, and abnormal psychology indicates that dated and oversimplified models of the etiology of Down's syndrome are being presented.

  10. Clinical update on metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Juan Diego Hernández-Camacho

    2017-12-01

    Full Text Available Metabolic syndrome has been defined as a global issue since it affects a lot of people. Numerous factors are involved in metabolic syndrome development. It has been described that metabolic syndrome has negative consequences on health. Consequently, a lot of treatments have been proposed to palliate it such as drugs, surgery or life style changes where nutritional habits have shown to be an important point in its management. The current study reviews the literature existing about the actual epidemiology of metabolic syndrome, the components involucrate in its appearance and progression, the clinical consequences of metabolic syndrome and the nutritional strategies reported in its remission. A bibliographic search in PubMed and Medline was performed to identify eligible studies. Authors obtained that metabolic syndrome is present in population from developed and undeveloped areas in a huge scale. Environmental and genetic elements are involucrate in metabolic syndrome development. Metabolic syndrome exponentially increased risk of cardiovascular disease, some types of cancers, diabetes mellitus type 2, sleep disturbances, etc. Nutritional treatments play a crucial role in metabolic syndrome prevention, treatment and recovery.

  11. Long-term prognosis of chronic kidney disease in non-ST elevation acute coronary syndrome treated with invasive strategy.

    Science.gov (United States)

    Roldán Torres, Ildefonso; Salvador Mercader, Inmaculada; Cabadés Rumbeu, Claudia; Díez Gil, José Luis; Ferrando Cervelló, José; Monteagudo Viana, Marta; Fernández Galera, Rubén; Mora Llabata, Vicente

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular outcomes after non-ST elevation acute coronary syndrome (NSTEACS). However, the information available on this specific population, is scarce. We evaluate the impact of CKD on long-term prognosis in patients with NSTEACS managed with invasive strategy. We conduct a prospective registry of patients with NSTEACS and coronary angiography. CKD was defined as a glomerular filtration rate < 60ml/min/1,73m 2 . The composite primary end-point was cardiac death and non fatal cardiovascular readmission. We estimated the cumulative probability and hazard rate (HR) of combined primary end-point at 3-years according to the presence or absence of CKD. We included 248 p with mean age of 66.9 years, 25% women. CKD was present at baseline in 67 patients (27%). Patients with CKD were older (74.9 vs. 63.9 years; P<.0001) with more prevalence of hypertension (89.6 vs. 66.3%; P<.0001), diabetes (53.7 vs. 35.9%; P=.011), history of heart failure (13.4 vs. 3.9%; P=.006) and anemia (47.8 vs. 16%; P<.0001). No differences in the extent of coronary artery disease. CKD was associated with higher cumulative probability (49.3 vs. 28.2%; log-rank P=.001) and HR of the primary combined end-point (HR: 1.94; CI95%: 1.12-3.27; P=.012). CKD was an independent predictor of adverse cardiovascular outcomes at 3-years (HR: 1.66; CI95%: 1.05-2.61; P=.03). In NSTEACS patients treated with invasive strategie CKD is associated independently with an increased risk of adverse cardiovascular outcomes at 3years. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA

    Directory of Open Access Journals (Sweden)

    Benjamin R. Doolittle

    2015-08-01

    Full Text Available Purpose: This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. Methods: Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. Results: The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5% in June 2009, increasing to 10/53 (18.9% in February 2010 (P<0.0001. From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5% to 45/53 (84.9% (P<0.0001, and that of high depersonalization increased from 42/66 (63.6% to 45/53 (84.9% (P=0.01. Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05. Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. Conclusion: Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains.

  13. Correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns at Yale University, New Haven, USA.

    Science.gov (United States)

    Doolittle, Benjamin R; Windish, Donna M

    2015-01-01

    This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5%) in June 2009, increasing to 10/53 (18.9%) in February 2010 (P<0.0001). From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5%) to 45/53 (84.9%) (P<0.0001), and that of high depersonalization increased from 42/66 (63.6%) to 45/53 (84.9%) (P=0.01). Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05). Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains.

  14. An innovative strategy for the molecular diagnosis of Usher syndrome identifies causal biallelic mutations in 93% of European patients.

    Science.gov (United States)

    Bonnet, Crystel; Riahi, Zied; Chantot-Bastaraud, Sandra; Smagghe, Luce; Letexier, Mélanie; Marcaillou, Charles; Lefèvre, Gaëlle M; Hardelin, Jean-Pierre; El-Amraoui, Aziz; Singh-Estivalet, Amrit; Mohand-Saïd, Saddek; Kohl, Susanne; Kurtenbach, Anne; Sliesoraityte, Ieva; Zobor, Ditta; Gherbi, Souad; Testa, Francesco; Simonelli, Francesca; Banfi, Sandro; Fakin, Ana; Glavač, Damjan; Jarc-Vidmar, Martina; Zupan, Andrej; Battelino, Saba; Martorell Sampol, Loreto; Claveria, Maria Antonia; Catala Mora, Jaume; Dad, Shzeena; Møller, Lisbeth B; Rodriguez Jorge, Jesus; Hawlina, Marko; Auricchio, Alberto; Sahel, José-Alain; Marlin, Sandrine; Zrenner, Eberhart; Audo, Isabelle; Petit, Christine

    2016-12-01

    Usher syndrome (USH), the most prevalent cause of hereditary deafness-blindness, is an autosomal recessive and genetically heterogeneous disorder. Three clinical subtypes (USH1-3) are distinguishable based on the severity of the sensorineural hearing impairment, the presence or absence of vestibular dysfunction, and the age of onset of the retinitis pigmentosa. A total of 10 causal genes, 6 for USH1, 3 for USH2, and 1 for USH3, and an USH2 modifier gene, have been identified. A robust molecular diagnosis is required not only to improve genetic counseling, but also to advance gene therapy in USH patients. Here, we present an improved diagnostic strategy that is both cost- and time-effective. It relies on the sequential use of three different techniques to analyze selected genomic regions: targeted exome sequencing, comparative genome hybridization, and quantitative exon amplification. We screened a large cohort of 427 patients (139 USH1, 282 USH2, and six of undefined clinical subtype) from various European medical centers for mutations in all USH genes and the modifier gene. We identified a total of 421 different sequence variants predicted to be pathogenic, about half of which had not been previously reported. Remarkably, we detected large genomic rearrangements, most of which were novel and unique, in 9% of the patients. Thus, our strategy led to the identification of biallelic and monoallelic mutations in 92.7% and 5.8% of the USH patients, respectively. With an overall 98.5% mutation characterization rate, the diagnosis efficiency was substantially improved compared with previously reported methods.

  15. Which is the best lipid-modifying strategy in metabolic syndrome and diabetes: fibrates, statins or both?

    Directory of Open Access Journals (Sweden)

    Tenenbaum Alexander

    2004-12-01

    Full Text Available Abstract Although less clinical intervention studies have been performed with fibrates than with statins, there are evidences indicating that fibrates may reduce risk of cardiovascular events. The potential clinical benefit of the fenofibrate will be specified by the ongoing Fenofibrate Intervention and Event Lowering in Diabetes (FIELD study, which rationale, methods and aims have been just published. Controlled clinical trials show similar or even greater cardiovascular benefits from statins-based therapy in patient subgroups with diabetes compared with overall study populations. Therefore, statins are the drug of first choice for aggressive lipid lowering actions and reducing risk of coronary artery disease in these patients. However, current therapeutic use of statins as monotherapy is still leaving many patients with mixed atherogenic dyslipidemia at high risk for coronary events. A combination statin/fibrate therapy may be often necessary to control all lipid abnormalities in patients with metabolic syndrome and diabetes adequately, since fibrates provide additional important benefits, particularly on triglyceride and HDL-cholesterol levels. Thus, this combined therapy concentrates on all the components of the mixed dyslipidemia that often occurs in persons with diabetes or metabolic syndrome, and may be expected to reduce cardiovascular morbidity and mortality. Safety concerns about some fibrates such as gemfibrozil may lead to exaggerate precautions regarding fibrate administration and therefore diminish the use of the seagents. However, other fibrates, such as bezafibrate and fenofibrate appear to be safer and better tolerated. We believe that a proper co-administration of statins and fibrates, selected on basis of their safety, could be more effective in achieving a comprehensive lipid control as compared with monotherapy.

  16. Strategies for improving outcome of assisted reproduction in women with polycystic ovary syndrome: systematic review and meta-analysis.

    Science.gov (United States)

    Kollmann, M; Martins, W P; Lima, M L S; Craciunas, L; Nastri, C O; Richardson, A; Raine-Fenning, N

    2016-12-01

    To identify, appraise and summarize the current evidence regarding the efficacy of strategies aimed at improving assisted reproductive techniques in women with polycystic ovary syndrome (PCOS). A comprehensive literature search of the standard medical databases was performed. The last electronic search was run in July 2015. The primary outcome measures were live birth/ongoing pregnancy and ovarian hyperstimulation syndrome (OHSS). The secondary outcome measures were clinical pregnancy and miscarriage. We screened 1021 records and completely assessed 173, finally including 66 studies in the quantitative analysis. Many different interventions were assessed, however the overall quality of the studies was low. We observed moderate-quality evidence that there is no clinically relevant difference in live birth/ongoing pregnancy rates (relative risk (RR), 0.95 (95% CI, 0.84-1.08)), or clinical pregnancy (RR, 1.02 (95% CI, 0.91-1.15)) when comparing antagonist and agonist protocols for ovarian stimulation. Additionally, we found low-quality evidence that metformin improves live birth/ongoing pregnancy (RR, 1.28 (95% CI, 1.01-1.63)) and clinical pregnancy rates (RR, 1.26 (95% CI, 1.04-1.53)) when compared with placebo or no intervention. We further found low-quality evidence that there is no clinically relevant difference in live birth/ongoing pregnancy rates (RR, 1.03 (95% CI, 0.80-1.34)) and clinical pregnancy rates (RR, 0.99 (95% CI, 0.81-1.22)) when comparing human menopausal gonadotropin for inducing ovulation and artificial preparation with estradiol valerate for endometrial preparation for frozen embryo transfer (FET). Low-quality evidence suggests that mannitol compared with no intervention (RR, 0.54 (95% CI, 0.39-0.77)) and antagonist protocols compared with agonist protocols (RR, 0.63 (95% CI, 0.49-0.80)) reduce rates of OHSS. There is low- to moderate-quality evidence suggesting that antagonist protocols are preferable to agonist ones, because

  17. Diagnostic strategies using physical examination are minimally useful in defining carpal tunnel syndrome in population-based research studies.

    Science.gov (United States)

    Descatha, A; Dale, A-M; Franzblau, A; Coomes, J; Evanoff, B

    2010-02-01

    We evaluated the utility of physical examination manoeuvres in the prediction of carpal tunnel syndrome (CTS) in a population-based research study. We studied a cohort of 1108 newly employed workers in several industries. Each worker completed a symptom questionnaire, a structured physical examination and nerve conduction study. For each hand, our CTS case definition required both median nerve conduction abnormality and symptoms classified as "classic" or "probable" on a hand diagram. We calculated the positive predictive values and likelihood ratios for physical examination manoeuvres in subjects with and without symptoms. The prevalence of CTS in our cohort was 1.2% for the right hand and 1.0% for the left hand. The likelihood ratios of a positive test for physical provocative tests ranged from 2.0 to 3.3, and those of a negative test from 0.3 to 0.9. The post-test probability of positive testing was study found that physical examination, alone or in combination with symptoms, was not predictive of CTS in a working population. We suggest using specific symptoms as a first-level screening tool, and nerve conduction study as a confirmatory test, as a case definition strategy in research settings.

  18. The place of occupational therapy in rehabilitation strategies of complex regional pain syndrome: Comparative study of 60 cases.

    Science.gov (United States)

    Rome, L

    2016-10-01

    The purpose of the study was to assess the value of combining occupational therapy (OT) with physical therapy (PT) for the rehabilitation of complex regional pain syndrome (CRPS) and to measure its effectiveness on activities of daily life. Sixty patients with CRPS type 1 were recruited and interviewed between September 1, 2014 and February 1, 2015. Thirty patients had undergone PT and thirty had undergone PT+OT. They were administered the short-form of the "Assessment of Life Habits" questionnaire (v.3.0 LIFE-H) created in Canada. This questionnaire consists of 16 items exploring activities of daily living, which were used to compare the effectiveness of the two rehabilitation protocols. The results of each test were submitted to the Wilcoxon test. After confirming the complexity of CRPS in terms of its etiology, clinical signs and progression, rehabilitation was effective, especially for pain. The patients who received PT+OT had on average 10% better dressing and undressing function, 25% better for meal preparation, and 20% better on personal care than those who underwent PT only. In CRPS, OT combined with PT brings a real benefit in restoring the essential activities of daily life. This strategy could be implemented as soon the diagnosis confirmed and continued for a very long time. It helps to avoid the risk of dependence on third parties. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  19. An economic comparison of a laparoscopic electrocautery strategy and ovulation induction with recombinant FSH in women with clomiphene citrate-resistant polycystic ovary syndrome

    NARCIS (Netherlands)

    van Wely, M.; Bayram, N.; van der Veen, F.; Bossuyt, P. M. M.

    2004-01-01

    BACKGROUND: Recombinant FSH (rFSH) is the current standard treatment for ovulation induction in women with polycystic ovary syndrome (PCOS) that do not respond to clomiphene citrate. Ovulation induction with rFSH is known to be costly due to the necessity of daily injections and intensive

  20. Burnout Syndrome of Teachers

    OpenAIRE

    Semrádová, Michaela

    2013-01-01

    The bachelor's thesis covers burnout syndrome of teachers. Defines burnout syndrome, describes its causes and symptoms. Describes teaching as helping profession and focousing on stressful situations at school. In the last chapter described different prevention strategies burnout syndrome. Key words: burnout syndrome, teaching, teacher, helping professions, beginning teacher, stress

  1. Strategy of Surgical Management of Peripheral Neuropathy Form of Diabetic Foot Syndrome in Ghana

    Directory of Open Access Journals (Sweden)

    W. M. Rdeini

    2014-01-01

    Full Text Available Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n=37 (68.51% and males n=17 (31.49% with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials, and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.

  2. Physiotherapeutic methods in treating patients with chronic abacterial prostatitis / chronic pelvic pain syndrome: current and development perspectives

    Directory of Open Access Journals (Sweden)

    Popkov V.M.

    2017-09-01

    Full Text Available Chronic abacterial prostatitis / chronic pelvic pain syndrome is one of the most common diseases in urological practice. Physical factors are widely used in treatment of this pathology. This literature review is devoted to study of role of physiotherapeutic methods in treatment of chronic abacterial prostatitis and prospects for development of this therapeutic direction.

  3. Evaluation of current prediction models for Lynch syndrome: updating the PREMM5 model to identify PMS2 mutation carriers

    NARCIS (Netherlands)

    A. Goverde (Anne); M.C.W. Spaander (Manon); D. Nieboer (Daan); A.M.W. van den Ouweland (Ans); W.N.M. Dinjens (Winand); H.J. Dubbink (Erik Jan); C. Tops (Cmj); S.W. Ten Broeke (Sanne W.); M.J. Bruno (Marco); R.M.W. Hofstra (Robert); E.W. Steyerberg (Ewout); A. Wagner (Anja)

    2017-01-01

    textabstractUntil recently, no prediction models for Lynch syndrome (LS) had been validated for PMS2 mutation carriers. We aimed to evaluate MMRpredict and PREMM5 in a clinical cohort and for PMS2 mutation carriers specifically. In a retrospective, clinic-based cohort we calculated predictions for

  4. Metabolic syndrome and subsequent risk of type 2 diabetes and cardiovascular disease in elderly women Challenging the current definition

    DEFF Research Database (Denmark)

    Møller, Katrine Dragsbæk; Neergaard, Jesper; Laursen, Janne Marie

    2016-01-01

    The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM...

  5. Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol).

    Science.gov (United States)

    Kang, Jian; Yao, Wanzhen; Cai, Baiqiang; Chen, Ping; Ling, Xia; Shang, Hongyan

    2016-12-01

    Asthma and chronic obstructive pulmonary disease (COPD) are the frequently occurring chronic airway diseases, and the overlapping syndrome observed in the majority of patients has been recently defined as asthma-COPD overlap syndrome (ACOS) by the Global Initiative for Chronic Obstructive Lung (GOLD, 2014) and Global initiative for Asthma (GINA, 2015). The proportion, features, and clinical practice of ACOS still remain elusive in China. We are conducting this multicenter, cross-sectional, observational study (NCT02600221) to investigate the distributions of chronic obstructive diseases in patients >40 years of age with chronic airflow limitation in China along with determination of the main clinical practice and features of these diseases. The study will also explore the factors that may influence the exacerbations and severity of ACOS in Chinese patients (>40 years of age). A total of 2,000 patients (age, ≥40 years; either sex) who are clinically diagnosed as having asthma, COPD/chronic bronchitis/emphysema, or ACOS for at least 12 months with airflow limitation [post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC): current situation, main clinical practice, and features of ACOS, asthma, and COPD conditions in Chinese patients. The insights will be helpful in designing optimal management strategies for ACOS and redefining the healthcare development programs.

  6. Is Exercise Stress Testing a Cost-Saving Strategy For Risk Assessment of Pediatric Wolff-Parkinson-White Syndrome Patients?

    Science.gov (United States)

    Moltedo, Jose M.; Iyer, Ramesh V.; Forman, Howard; Fahey, John; Rosenthal, Geoffrey; Snyder, Christopher S.

    2006-01-01

    Background: In Wolff-Parkinson-White syndrome (WPW) patients the loss of pre-excitation in a single heartbeat during exercise stress testing (EST) is a predictor of low risk of sudden death. The purpose of this study was to: 1) assess the frequency of loss of pre-excitation in a single heartbeat during exercise testing, and 2) compare the cost of EST versus trans-catheter electrophysiology study (EPS) in the risk assessment of WPW patients. Methods: A retrospective review of 50 cases of patients with WPW who underwent EST was conducted including demographics, history of supraventricular tachycardia, associated congenital heart disease, maximum heart rate achieved, and loss of pre-excitation in a single heartbeat. Hospital costs of EST and EPS were compared. Results: Of the 50 patients who underwent EST, 4 (8%), lost pre-excitation in a single heartbeat during EST. No differences were found regarding gender, age at diagnosis or EST, history of supraventricular tachycardia, presence of congenital heart disease or maximal heart rate. A cost comparison, utilizing the cost data: EST ($62.75) and EPS ($5,597) found EST to be a cost-saving approach in WPW patients. With 4 patients losing pre-excitation during EST, the cost saving of EST was $22,388 for this population of WPW patients. Conclusions: A frequency of 8% loss of pre-excitation was found in a pediatric sample that underwent EST. Additionally, EST was shown to be a cost-saving strategy in risk assessment of pediatric WPW patients. PMID:21845141

  7. Effect of protective lung ventilation strategy combined with lung recruitment maneuver in patients with acute respiratory distress syndrome (ARDS

    Directory of Open Access Journals (Sweden)

    Sheng Yu

    2017-01-01

    Full Text Available Objective: To evaluate the efficacy and safety of protective lung ventilation strategy combined with lung recruitment maneuver (RM in the treatment patients with acute respiratory distress syndrome (ARDS.Methods: Totally 74 patients with ARDS admitted to the Department of Intensive Care Unit, Changshu Second People's Hospital in Jiangsu Province between September 2010 and June 2013 were selected and randomly divided into lung recruitment group and non-lung recruitment group, and the initial ventilation solution for both groups was synchronized intermittent mandatory ventilation (SIMV. For RM, SIMV mode (pressure control and pressure support was adopted. Positive end expiratory pressure (PEEP was increased by 5 cm H2O every time and maintained for 40-50 s before entering the next increasing period, and the peak airway pressure was kept below 45 cm H2O. After PEEP reached the maximum value, it was gradually reduced by 5 cm H2O every time and finally maintained at 15 cm H2O for 10 min.Results: A total of 74 patients with mean age of (49.0±18.6 years old were enrolled, 36 patients were enrolled in lung recruitment maneuver (RM group and 38 patients were enrolled into non-lung recruitment maneuver (non-RM group. 44 were male and accounted for 59.5% of all the patients. For the indicators such as PEEP, pressure support (PS, plateau airway pressure (Pplat, peak airway pressure (Ppeak, vital capacity (VC and fraction of inspired oxygen (FiO2, no statistical differences in the indicators were found between the RM group and non-RM group on D1, D3 and D7 (P>0.05, except that only FiO2 of RM group on D7 was significantly lower than that of non-RM group (47.2±10.0 vs. (52.2±10.5, P0.05. 28-day mortality, ICU mortality and in-hospital mortality were 25% vs. 28.9%, 25% vs. 26.3% and 36.1% vs. 39.5% respectively between RM group and non-RM group (all P>0.05.Conclusion: Protective lung ventilation strategy combined with lung recruitment maneuver can improve

  8. Effects on Pulmonary Vascular Mechanics of Two Different Lung-Protective Ventilation Strategies in an Experimental Model of Acute Respiratory Distress Syndrome.

    Science.gov (United States)

    Santos, Arnoldo; Gomez-Peñalver, Eva; Monge-Garcia, M Ignacio; Retamal, Jaime; Borges, João Batista; Tusman, Gerardo; Hedenstierna, Goran; Larsson, Anders; Suarez-Sipmann, Fernando

    2017-11-01

    To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. Experimental study. University animal research laboratory. Twelve pigs (30.8 ± 2.5 kg). Acute respiratory distress syndrome was induced by repeated lung lavages and injurious mechanical ventilation. Thereafter, animals were randomized to 4 hours ventilation according to the Acute Respiratory Distress Syndrome Network protocol or to an open lung approach strategy. Pressure and flow sensors placed at the pulmonary artery trunk allowed continuous assessment of pulmonary artery resistance, effective elastance, compliance, and reflected pressure waves. Respiratory mechanics and gas exchange data were collected. Acute respiratory distress syndrome led to pulmonary vascular mechanics deterioration. Four hours after randomization, pulmonary vascular mechanics was similar in Acute Respiratory Distress Syndrome Network and open lung approach: resistance (578 ± 252 vs 626 ± 153 dyn.s/cm; p = 0.714), effective elastance, (0.63 ± 0.22 vs 0.58 ± 0.17 mm Hg/mL; p = 0.710), compliance (1.19 ± 0.8 vs 1.50 ± 0.27 mL/mm Hg; p = 0.437), and reflection index (0.36 ± 0.04 vs 0.34 ± 0.09; p = 0.680). Open lung approach as compared to Acute Respiratory Distress Syndrome Network was associated with improved dynamic respiratory compliance (17.3 ± 2.6 vs 10.5 ± 1.3 mL/cm H2O; p mechanics similarly. The use of higher positive end-expiratory pressures in the open lung approach strategy did not worsen pulmonary vascular mechanics, improved lung mechanics, and gas exchange but at the expense of a lower cardiac index.

  9. Specific features of the clinical and laboratory diagnosis of Lesch—Nyhan syndrome and current therapy options

    Directory of Open Access Journals (Sweden)

    M. I. Yablonskaya

    2015-01-01

    Full Text Available The rare hereditary diseases encountered in the practice of pediatricians, pediatric neurologists, and geneticists include Lesch—Nyhan syndrome associated with purine metabolic disorders caused by mutations in the HPRT1 gene encoding the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT. HGPRT deficiency gives rise to hyperuricemia, hyperuricemic nephropathy, and a CNS lesion reminiscent of dystonic or hyperkinetic infantile cerebral paralysis concurrent with a propensity to have autoaggressive behavior. The diagnosis is based on a range of history data, characteristic neurological symptoms, the detection of high blood and urine uric acid levels, and the identification of pathogenic mutagens in the HPRT1 gene. Early diagnosis contributes to timely therapy and assists in medical genetic counseling. The paper describes a clinical case of a boy with Lesch-Nyhan syndrome and elucidates the problems of diagnosis and treatment of this disease.

  10. Assessment of Current Knowledge about the Effectiveness of School Desegregation Strategies. Summary. Volume I: Strategies for Effective Desegregation: A Synthesis of Findings.

    Science.gov (United States)

    Hawley, Willis D.; And Others

    This project report examines strategies for effective school desegregation based on case studies of individual schools, national school surveys, ethnographic studies of classrooms, trend analyses, opinion surveys and conference interviews, and court documents. The strategies identified in the report include the attainment of one or more of the…

  11. Budget impact analysis of rivaroxaban vs. warfarin anticoagulation strategy for direct current cardioversion in non-valvular atrial fibrillation patients: the MonaldiVert Economic Study.

    Science.gov (United States)

    Russo, Vincenzo; Rago, Anna; Papa, Andrea A; Bianchi, Valter; Tavoletta, Vincenzo; DE Vivo, Stefano; Cavallaro, Ciro; Nigro, Gerardo; D'Onofrio, Antonio

    2018-02-01

    Rivaroxaban is the first novel oral anticoagulant to receive regulatory approval for non-valvular atrial fibrillation (NVAF) patients who require cardioversion. The MonaldiVert real life experience showed positive benefit-risk profile of short term rivaroxaban administration for transesophageal echocardiogram guided cardioversion in patients who had not achieved adequate pre-procedural vitamin K antagonist (VKA) anticoagulation. Aim of our study was to perform a budget impact analysis of MonaldiVert anticoagulation strategy for direct current cardioversion in NVAF patients and to compare the following costs borne by the Regional Healthcare System (RHS) with those for a hypothetical cohort of identical patients underwent from the beginning to early rivaroxaban treatment before direct current cardioversion. The mean costs per each NVAF patient treated with VKA strategy and rivaroxaban rescue strategy were € 134.53 and € 189.83, respectively. Considering a hypothetical scenario in which all study population would be treated from the beginning with rivaroxaban (rivaroxaban early strategy), the mean cost per patient would have been € 81.11. The total cost borne by the RHS, including the cost of the cardioversion procedure, for the two therapeutic strategies carried out at Monaldi Hospital (VKA strategy and Rivaroxaban rescue strategy) was € 88,458.53. The total cost would be borne by the RHS for rivaroxaban early strategy, if applied to all study population, would have been € 69,989.15 with a saving of € 18,469.38 compared to the actually applied strategy. Rivaroxaban rescue strategy for transesophageal echocardiography guided direct current cardioversion in NVAF patients, who had not achieved adequate pre-procedural VKA anticoagulation, is an effective and safe strategy, which allows to not delay the procedure, reducing times and wastage of cardioversion slots, without substantial costs increase.

  12. [Cockett's syndrome, May-Thurner syndrome, or iliac vein compression syndrome].

    Science.gov (United States)

    Gil Martín, A R; Carreras Aja, M; Arrieta Ardieta, I; Labayen Azparren, I

    2014-01-01

    Iliac vein compression syndrome (also known as May-Thurner syndrome or Cockett's syndrome) is a rare clinical entity in which the left common iliac vein is compressed when it passes between the right common iliac artery and the spine. The sustained compression and trauma caused by the pulsatile force of the artery on the vein damage the intima and lead to the formation of membranes or bands in the vascular lumen that hinder or obstruct the flow of blood in the vein, favoring thrombus formation. The current treatment strategy of choice is endovascular vein patch angioplasty and stenting with the aim of improving the caliber of the lumen and enabling normal venous drainage. We present two cases of May-Thurner syndrome and review the clinical and CT findings. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  13. Mixed methods research in tobacco control with youth and young adults: A methodological review of current strategies.

    Directory of Open Access Journals (Sweden)

    Craig S Fryer

    Full Text Available Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology.Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research.We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs.The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.

  14. Simultaneous improvement in short circuit current, open circuit voltage, and fill factor of polymer solar cells through ternary strategy.

    Science.gov (United States)

    An, Qiaoshi; Zhang, Fujun; Li, Lingliang; Wang, Jian; Sun, Qianqian; Zhang, Jian; Tang, Weihua; Deng, Zhenbo

    2015-02-18

    We present a smart strategy to simultaneously increase the short circuit current (Jsc), the open circuit voltage (Voc), and the fill factor (FF) of polymer solar cells (PSCs). A two-dimensional conjugated small molecule photovoltaic material (SMPV1), as the second electron donor, was doped into the blend system of poly(3-hexylthiophene) (P3HT) and [6,6]-phenyl-C71-butyric acid methyl (PC71BM) to form ternary PSCs. The ternary PSCs with 5 wt % SMPV1 doping ratio in donors achieve 4.06% champion power conversion efficiency (PCE), corresponding to about 21.2% enhancement compared with the 3.35% PCE of P3HT:PC71BM-based PSCs. The underlying mechanism on performance improvement of ternary PSCs can be summarized as (i) harvesting more photons in the longer wavelength region to increase Jsc; (ii) obtaining the lower mixed highest occupied molecular orbital (HOMO) energy level by incorporating SMPV1 to increase Voc; (iii) forming the better charge carrier transport channels through the cascade energy level structure and optimizing phase separation of donor/acceptor materials to increase Jsc and FF.

  15. Mixed methods research in tobacco control with youth and young adults: A methodological review of current strategies.

    Science.gov (United States)

    Fryer, Craig S; Seaman, Elizabeth L; Clark, Rachael S; Plano Clark, Vicki L

    2017-01-01

    Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology. Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research. We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs. The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.

  16. Sturge-Weber syndrome. The current neuro-imaging data; Syndrome de Sturge-Weber. Donnees actuelles de l'imagerie neuroradiologique

    Energy Technology Data Exchange (ETDEWEB)

    Boukobza, M.; Cambra, M.R.; Merland, J.J.; Enjolras, O. [Hopital Lariboisiere, 75 - Paris (France)

    2000-07-01

    Sturge-Weber syndrome (SWS) is a rare congenital sporadic disease with neuro-ocular and cutaneous vascular findings. Clinically, the full-blown condition consists of a facial port-wine stain (PWS) the V1 facial trigeminal skin area, alone or in combination with V2 and V3 PWS, seizures and ocular abnormalities (glaucoma and choroidal angioma). Radiologically, a leptomeningeal (pial) capillary and venous malformation, mostly located in the parieto-occipital area, cerebral atrophy and calcifications are demonstrated. An ipsilateral enlarged choroid plexus may be an early anatomic symptom. Development neuro-diagnostic technique for the screening of infants with an at-risk V1 PWS, as well as for the follow-up of patients with evidence SWS. Accelerated myelination in the involved hemisphere may be early diagnostic feature before 6 months of age. Later, hyperintensity of white matter on T2 is considered a symptom of gliosis. Clinically, progression of the diseases is associated with anatomic changes and correlates with the extent of the pial vascular anomaly, extent and severity of cerebral atrophy, and white matter abnormalities. A neonatal neuro-imaging work-up, using CT or MRI, may not demonstrate the pial anomaly and should be repeated after 6 to 12 months in an at-risk infant with V1 PWS. (authors)

  17. Consensus on context-specific strategies for reducing the stigma of human immunodeficiency virus/acquired immunodeficiency syndrome in Zambézia Province, Mozambique

    OpenAIRE

    Mukolo, Abraham; Torres, Isabel; Bechtel, Ruth M.; Sidat, Mohsin; Vergara, Alfredo E.

    2014-01-01

    Stigma has been implicated in poor outcomes of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) care. Reducing stigma is important for HIV prevention and long-term treatment success. Although stigma reduction interventions are conducted in Mozambique, little is known about the current nature of stigma and the efficacy and effectiveness of stigma reduction initiatives. We describe action research to generate consensus on critical characteristics of HIV stigma and an...

  18. Elimination of Guinea Worm Disease in Ethiopia; Current Status of the Disease's, Eradication Strategies and Challenges to the End Game.

    Science.gov (United States)

    Beyene, Habtamu Bedimo; Bekele, Abyot; Shifara, Amanu; Ebstie, Yehenew A; Desalegn, Zelalem; Kebede, Zeyede; Mulugeta, Abate; Deribe, Kebede; Tadesse, Zerihun; Abebe, Tamrat; Kebede, Biruck; Abrha, Getaneh; Jima, Daddi

    2017-01-01

    Dracunculiasis, also named Guinea Worm Disease (GWD), is one of the Neglected Tropical Diseases (NTDs) caused by a parasitic nematode known as Dracunculus medinensis and has been known since antiquity as 'fiery serpent' from Israelites. It is transmitted to humans via drinking contaminated water containing infective copepods. Given, its feasibility for eradication, the Guinea Worm Eradication Program (GWEP) was launched in 1980 with the aim of eradicating the disease. Since its inception, GWEP has made an extraordinary progress in interrupting transmission. Globally, the number of reported cases reduced from 3.5 million in 20 countries in 1986 to only 22 cases in 2015 from only four countries namely South Sudan, Mali, Chad and Ethiopia. Since Mali has interrupted transmission of GWD in 2016, currently, the disease remains endemic in only three sub-Saharan African countries namely, South Sudan, Chad and Ethiopia. Each endemic country has its own national Guinea Worm Eradication Program. In Ethiopia, the Ethiopian Dracunculiasis Eradication Program (EDEP) which was established in 1993 has made remarkable move towards interruption of disease transmission and now the endgame is fast approaching. The EDEP with support mainly from The Carter Center, WHO, and UNICEF has reduced GWD by more than 99% from 1994 to 2015. In 2015, only 3 indigenous cases in humans and 14 in animals (13 in dogs and 1 in baboon) were reported. In 2016, 3 human cases, 14 dogs and 2 baboon infections were reported.. Refugee influx from the Republic of South Sudan (RSS), increased animal infections with unknown role in transmission of Dracunculiasis, the presence of hard to reach communities and lack of safe water sources in remote non-village areas remain among important challenges at this final stage of GWD eradication in Ethiopia. This paper reviews progress made towards Guinea Worm Eradication with a focus on the experience of the Ethiopian Dracunculiasis Eradication Program (EDEP), and

  19. The Current Status of E-learning and Strategies to Enhance Educational Competitiveness in Korean Higher Education

    Directory of Open Access Journals (Sweden)

    Junghoon Leem

    2007-03-01

    Full Text Available The purpose of this study was to examine the current status of e-Learning in Korean higher education and find ways to encourage the further use and development of e-Learning systems that aim to enhance Korea's academic competitiveness. A total of 201 universities in Korea (27 national and public, 163 private, and 11 national universities of education were examined in this study. At the time of the study, 85 percent of the universities and colleges had investigated implementing e-Learning. There were special e-Learning teams in most national and public universities, as well as private universities and colleges. Findings from this study found that both teachers and learners alike, lacked meaningful support systems and opportunities to actively participate in e-Learning programs. Although such lack of support was found to be endemic, such lack of support and opportunity was found to be more accute in private universities, private colleges, universities of education, than mid-sized, small-sized, and provincial universities and colleges. Except for a few mid- and small-sized universities and colleges, most large universities and colleges were equipped with technical support such as infrastructure and operational platforms. These same schools, however, did not provide institutional support, nor did they employ appropriate policies needed to further the quality and enhancement of e-Learning offerings. Also, there was no meaningful link found between schools and industry, nor was there adequate financial support in place for the implementation of e-Learning systems, simply because many universities failed to allocate sufficient funding for e-Learning.In conclusion, the strategies for enhancing university competitiveness through e-Learning are as follows: 1 establishing support strategies according to the types of universities; 2 developing quality assurance systems for e-Learning; 3 enhancing support systems for professors and learners; 4 developing

  20. Lynch Syndrome: Female Genital Tract Cancer Diagnosis and Screening.

    Science.gov (United States)

    Mills, Anne M; Longacre, Teri A

    2016-06-01

    Lynch syndrome is responsible for approximately 5% of endometrial cancers and 1% of ovarian cancers. The molecular basis for Lynch syndrome is a heritable functional deficiency in the DNA mismatch repair system, typically due to a germline mutation. This review discusses the rationales and relative merits of current Lynch syndrome screening tests for endometrial and ovarian cancers and provides pathologists with an informed algorithmic approach to Lynch syndrome testing in gynecologic cancers. Pitfalls in test interpretation and strategies to resolve discordant test results are presented. The potential role for next-generation sequencing panels in future screening efforts is discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Science.gov (United States)

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou

    2016-07-22

    It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, EMBASE, MEDLINE, CINAHL, and Web of Science for studies published up to July 2015 in which pulmonary compliance or the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio was assessed in ICU patients without ALI or ARDS, who received mechanical ventilation via different strategies. The data for study characteristics, methods, and outcomes were extracted. We assessed the studies for eligibility, extracted the data, pooled the data, and used a Bayesian fixed-effects model to combine direct comparisons with indirect evidence. Seventeen randomized controlled trials including a total of 575 patients who received one of six ventilation strategies were included for network meta-analysis. Among ICU patients without ALI or ARDS, strategy C (lower tidal volume (VT) + higher positive end-expiratory pressure (PEEP)) resulted in the highest PaO2/FIO2 ratio; strategy B (higher VT + lower PEEP) was associated with the highest pulmonary compliance; strategy A (lower VT + lower PEEP) was associated with a shorter length of ICU stay; and strategy D (lower VT + zero end-expiratory pressure (ZEEP)) was associated with the lowest PaO2/FiO2 ratio and pulmonary compliance. For ICU patients without ALI or ARDS, strategy C (lower VT + higher PEEP) was associated with the highest PaO2/FiO2 ratio. Strategy B (higher VT + lower PEEP) was superior to the other strategies in improving pulmonary

  2. Simulation and RTDS Hardware Implementation of SHAF for Mitigation of Current Harmonics with p-q and Id-Iq Control Strategies Using PI Controller

    Directory of Open Access Journals (Sweden)

    A. K. Panda

    2011-06-01

    Full Text Available Control strategies for extracting the three-phase reference currents for shunt active power filters are compared, evaluating their performance under different source conditions in MATLAB/Simulink environment and also with Real Time Digital Simulator (RTDS Hardware. When the supply voltages are balanced and sinusoidal, the two control strategies are converging to the same compensation characteristics but when the supply voltages are distorted and/or un-balanced sinusoidal, these control strategies result in different degrees of compensation in harmonics. The p-q control strategy is unable to yield an adequate solution when source voltages are not ideal. Extensive Simulations are carried out with PI controller for both p-q and Id-Iq control strategies for different voltage conditions and adequate results were presented. The 3-ph 4-wire SHAF system is also implemented on RTDS Hardware to further verify its effectiveness. The detailed simulation and RTDS Hardware results are included.

  3. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study.

    NARCIS (Netherlands)

    Hirsch, A.; Windhausen, F.; Tijssen, J.G.P.; Verheugt, F.W.A.; Cornel, J.H.; Winter, R.J. de

    2007-01-01

    BACKGROUND: The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or

  4. Long-term outcome after an early invasive versus selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin T (the ICTUS trial): a follow-up study

    NARCIS (Netherlands)

    Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; Verheugt, Freek W. A.; Hein Cornel, Jan; de Winter, Robbert J.

    2007-01-01

    BACKGROUND: The ICTUS trial was a study that compared an early invasive with a selective invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (nSTE-ACS). The study reported no difference between the strategies for frequency of death, myocardial infarction, or

  5. Beyond Brooding on Oncometabolic Havoc in IDH-Mutant Gliomas and AML: Current and Future Therapeutic Strategies

    Directory of Open Access Journals (Sweden)

    Hanumantha Rao Madala

    2018-02-01

    Full Text Available Isocitrate dehydrogenases 1 and 2 (IDH1,2, the key Krebs cycle enzymes that generate NADPH reducing equivalents, undergo heterozygous mutations in >70% of low- to mid-grade gliomas and ~20% of acute myeloid leukemias (AMLs and gain an unusual new activity of reducing the α-ketoglutarate (α-KG to D-2 hydroxyglutarate (D-2HG in a NADPH-consuming reaction. The oncometabolite D-2HG, which accumulates >35 mM, is widely accepted to drive a progressive oncogenesis besides exacerbating the already increased oxidative stress in these cancers. More importantly, D-2HG competes with α-KG and inhibits a large number of α-KG-dependent dioxygenases such as TET (Ten-eleven translocation, JmjC domain-containing KDMs (histone lysine demethylases, and the ALKBH DNA repair proteins that ultimately lead to hypermethylation of the CpG islands in the genome. The resulting CpG Island Methylator Phenotype (CIMP accounts for major gene expression changes including the silencing of the MGMT (O6-methylguanine DNA methyltransferase repair protein in gliomas. Glioma patients with IDH1 mutations also show better therapeutic responses and longer survival, the reasons for which are yet unclear. There has been a great surge in drug discovery for curtailing the mutant IDH activities, and arresting tumor proliferation; however, given the unique and chronic metabolic effects of D-2HG, the promise of these compounds for glioma treatment is uncertain. This comprehensive review discusses the biology, current drug design and opportunities for improved therapies through exploitable synthetic lethality pathways, and an intriguing oncometabolite-inspired strategy for primary glioblastoma.

  6. Recruitment Issues and Strategies for Adults Who Are Not Currently Participating in Literacy and Adult Basic Education (ABE) Programs.

    Science.gov (United States)

    Kohring, Aaron

    Adult basic education (ABE) and literacy programs have used many different strategies and tools to recruit new students. A small sampling of Tennessee ABE programs shows the more effective recruitment strategies are word-of-mouth referrals; newspaper advertisements and articles; fliers; brochures; posters, radio messages, and public service…

  7. Asymptomatic Wolff–Parkinson–White syndrome: incidental ECG diagnosis and a review of literature regarding current treatment

    Science.gov (United States)

    Liu, Alexander; Pusalkar, Pawan

    2011-01-01

    A 19-year-old male presented with periorbital cellulitis responsive to intravenous antibiotics. A routine ECG on admission showed slurred upstroke of the QRS complexes consistent with Wolff–Parkinson–White syndrome (WPW). He has never experienced any cardiac-related symptoms. Once the periorbital cellulitis resolved, he was referred to the specialist cardiology ablation clinic. He was counselled on the arrythmogenic risks of untreated WPW and the potential complications of radiofrequency catheter ablation (RFCA). He decided to go ahead with electrophysiological studies and RFCA, which took place successfully. This case highlights the importance of routine ECG in the diagnosis of asymptomatic WPW. The use of prophylactic ablation of asymptomatic WPW is controversial and should be considered on a case-specific basis. PMID:22693197

  8. Current Views on Therapeutic and Preventive Nutrition and the Most Effectivenes European Diet in Metabolic Syndrome and Its Components

    Directory of Open Access Journals (Sweden)

    D.K. Miloslavskyi

    2016-05-01

    Full Text Available This review contains literature information about pathogenetic and pathophysiological mechanisms of metabolic syndrome development, its main components, national recommendations on nutrition for the citizens of some countries, the results of multicenter studies on the role of alimentary factors, molecular targets of favorable effects of certain nutrients in this pathology. The basic dietary recommendations, the most important and special European diets with proven efficacy (Mediterranean Diet, DASH diet, TLC, D. Ornish, the Polymeal diet, Omni Heart, the Mayo clinic, Weight Watchers, the characteristics of their prescription in hypertension, atherosclerosis, dyslipidemia, purine metabolism disorders, obesity, diabetes mellitus type 2, as well as a short recommendation on lifestyle modification and physical activity increasing in these patients were present.

  9. An improved synchronous reference frame current control strategy for a photovoltaic grid-connected inverter under unbalanced and nonlinear load conditions

    DEFF Research Database (Denmark)

    Naderipour, Amirreza; Asuhaimi Mohd Zin, Abdullah; Bin Habibuddin, Mohd Hafiz

    2017-01-01

    In recent years, renewable energy sources have been considered the most encouraging resources for grid and off-grid power generation. This paper presents an improved current control strategy for a three-phase photovoltaic grid-connected inverter (GCI) under unbalanced and nonlinear load conditions....... It is challenging to suppress the harmonic content in the output current below a pre-set value in the GCI. It is also difficult to compensate for unbalanced loads even when the grid is under disruption due to total harmonic distortion (THD) and unbalanced loads. The primary advantage and objective of this method...... is to effectively compensate for the harmonic current content of the grid current and microgrid without the use of any compensation devices, such as active and passive filters. This method leads to a very low THD in both the GCI currents and the current exchanged with the grid. The control approach is designed...

  10. Design and baseline characteristics of a coronary heart disease prospective cohort: two-year experience from the strategy of registry of acute coronary syndrome study (ERICO study

    Directory of Open Access Journals (Sweden)

    Alessandra C. Goulart

    2013-01-01

    Full Text Available OBJECTIVES: To describe the ERICO study (Strategy of Registry of Acute Coronary Syndrome, a prospective cohort to investigate the epidemiology of acute coronary syndrome. METHODS: The ERICO study, which is being performed at a secondary general hospital in São Paulo, Brazil, is enrolling consecutive acute coronary syndrome patients who are 35 years old or older. The sociodemographic information, medical assessments, treatment data and blood samples are collected at admission. After 30 days, the medical history is updated, and additional blood and urinary samples are collected. In addition, a retinography, carotid intima-media thickness, heart rate variability and pulse-wave velocity are performed. Questionnaires about food frequency, physical activity, sleep apnea and depression are also applied. At six months and annually after an acute event, information is collected by telephone. RESULTS: From February 2009 to September 2011, 738 patients with a diagnosis of an acute coronary syndrome were enrolled. Of these, 208 (28.2% had ST-elevation myocardial infarction (STEMI, 288 (39.0% had non-ST-elevation myocardial infarction (NSTEMI and 242 (32.8% had unstable angina (UA. The mean age was 62.7 years, 58.5% were men and 77.4% had 8 years or less of education. The most common cardiovascular risk factors were hypertension (76% and sedentarism (73.4%. Only 29.2% had a prior history of coronary heart disease. Compared with the ST-elevation myocardial infarction subgroup, the unstable angina and non-ST-elevation myocardial infarction patients had higher frequencies of hypertension, diabetes, prior coronary heart disease (p<0.001 and dyslipidemia (p = 0.03. Smoking was more frequent in the ST-elevation myocardial infarction patients (p = 0.006. CONCLUSIONS: Compared with other hospital registries, our findings revealed a higher burden of CV risk factors and less frequent prior CHD history.

  11. Zero-Voltage Switching PWM Strategy Based Capacitor Current-Balancing Control for Half-Bridge Three-Level DC/DC Converter

    DEFF Research Database (Denmark)

    Liu, Dong; Deng, Fujin; Zhang, Qi

    2018-01-01

    The current imbalance among the two input capacitors is one of the important issues of the half-bridge threelevel (HBTL) DC/DC converter, which would affect system performance and reliability. In this paper, a zero-voltage switching (ZVS) pulse-wide modulation (PWM) strategy including two operation...

  12. Current and emerging treatment strategies for children with progressive chiasmatic-hypothalamic glioma diagnosed as infants: a web-based survey

    NARCIS (Netherlands)

    Azizi, Amedeo A.; Schouten-van Meeteren, Antoinette Y. N.

    2018-01-01

    Treatment of infant hypothalamic chiasmatic glioma (iCHG) is challenging, about 30% of the children progress during chemotherapy. Despite subsequent treatments the 5 year overall-survival rate is only 70%. This study investigates treatment strategies currently applied for progressive iCHG. A

  13. Input-Parallel Output-Parallel Three-Level DC/DC Converters With Interleaving Control Strategy for Minimizing and Balancing Capacitor Ripple Currents

    DEFF Research Database (Denmark)

    Liu, Dong; Deng, Fujin; Gong, Zheng

    2017-01-01

    In this paper, the input-parallel output-parallel (IPOP) three-level (TL) DC/DC converters associated with the interleaving control strategy are proposed for minimizing and balancing the capacitor ripple currents. The proposed converters consist of two four-switch half-bridge three-level (HBTL) DC...

  14. U.S. Forest Service Research and Development (USFS R/D) national science strategy on White Nose Syndrome (WNS)

    Science.gov (United States)

    Sybill Amelon; Robert T. Brooks; Jessie Glaeser; Megan Friggens; Daniel Lindner; Susan C. Loeb; Ann Lynch; Drew Minnis; Roger Perry; Mary M. Rowland; Monica Tomosy; Ted Weller

    2012-01-01

    The National Plan for Assisting States, Federal Agencies, and Tribes in Managing White-Nose Syndrome in Bats (National WNS Plan), is a document prepared jointly by the U.S. Departments of the Interior, Agriculture, and Defense, along with the Association of Fish and Wildlife Agencies. This document provides a strategic framework for the investigation and management of...

  15. Route-Learning Strategies in Typical and Atypical Development; Eye Tracking Reveals Atypical Landmark Selection in Williams Syndrome

    Science.gov (United States)

    Farran, E. K.; Formby, S.; Daniyal, F.; Holmes, T.; Van Herwegen, J.

    2016-01-01

    Background: Successful navigation is crucial to everyday life. Individuals with Williams syndrome (WS) have impaired spatial abilities. This includes a deficit in spatial navigation abilities such as learning the route from A to B. To-date, to determine whether participants attend to landmarks when learning a route, landmark recall tasks have been…

  16. An innovative strategy for the molecular diagnosis of Usher syndrome identifies causal biallelic mutations in 93% of European patients

    DEFF Research Database (Denmark)

    Bonnet, Crystel; Riahi, Zied; Chantot-Bastaraud, Sandra

    2016-01-01

    Usher syndrome (USH), the most prevalent cause of hereditary deafness-blindness, is an autosomal recessive and genetically heterogeneous disorder. Three clinical subtypes (USH1-3) are distinguishable based on the severity of the sensorineural hearing impairment, the presence or absence...

  17. Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials.

    Science.gov (United States)

    Jobs, Alexander; Mehta, Shamir R; Montalescot, Gilles; Vicaut, Eric; Van't Hof, Arnoud W J; Badings, Erik A; Neumann, Franz-Josef; Kastrati, Adnan; Sciahbasi, Alessandro; Reuter, Paul-Georges; Lapostolle, Frédéric; Milosevic, Aleksandra; Stankovic, Goran; Milasinovic, Dejan; Vonthein, Reinhard; Desch, Steffen; Thiele, Holger

    2017-08-19

    A routine invasive strategy is recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, optimal timing of invasive strategy is less clearly defined. Individual clinical trials were underpowered to detect a mortality benefit; we therefore did a meta-analysis to assess the effect of timing on mortality. We identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD42015018988). We included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180-360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 0·81, 95% CI 0·64-1·03; p=0·0879). In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0·761, 95% CI 0·581-0·996), diabetes (0·67, 0·45-0·99), a GRACE risk score more than 140 (0·70, 0·52-0·95), and aged 75 years older (0·65, 0·46-0·93), although tests for interaction were inconclusive. An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Cardio-renal syndrome

    OpenAIRE

    Gnanaraj, Joseph; Radhakrishnan, Jai

    2016-01-01

    Cardio-renal syndrome is a commonly encountered problem in clinical practice. Its pathogenesis is not fully understood. The purpose of this article is to highlight the interaction between the cardiovascular system and the renal system and how their interaction results in the complex syndrome of cardio-renal dysfunction. Additionally, we outline the available therapeutic strategies to manage this complex syndrome.

  19. Effect of Adding Interferential Current in an Exercise and Manual Therapy Program for Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Clinical Trial.

    Science.gov (United States)

    Gomes, Cid André Fidelis de Paula; Dibai-Filho, Almir Vieira; Moreira, William Arruda; Rivas, Shirley Quispe; Silva, Emanuela Dos Santos; Garrido, Ana Claudia Bogik

    The purpose of this study was to measure the additional effect of adding interferential current (IFC) to an exercise and manual therapy program for patients with unilateral shoulder impingement syndrome. Forty-five participants were randomly assigned to group 1 (exercise and manual therapy), group 2 (exercise and manual therapy + IFC), or group 3 (exercise and manual therapy + placebo ultrasound). Individuals participated in 16 treatment sessions, twice a week for 8 weeks. The primary outcome of the study was total score of the Shoulder Pain and Disability Index (SPADI). The secondary outcomes were the pain and disability subscales of SPADI, Numeric Rating Scale, and Pain-Related Self-Statement Scale. Adjusted between-group mean differences (MDs) and 95% confidence intervals (CIs) were calculated using linear mixed models. After 16 treatment sessions, statistically significant but not clinically important differences were identified in favor of the exercise and manual therapy program alone in the SPADI-total (group 1 vs group 2, MD 11.12 points, 95% CI 5.90-16.35; group 1 vs group 3, MD 13.43 points, 95% CI 8.21-18.65). Similar results were identified for secondary outcomes. The addition of IFC does not generate greater clinical effects in an exercise and manual therapy program for individuals with unilateral shoulder impingement syndrome. Copyright © 2018. Published by Elsevier Inc.

  20. Current evidence on the health-beneficial effects of berry fruits in the prevention and treatment of metabolic syndrome.

    Science.gov (United States)

    Kowalska, Katarzyna; Olejnik, Anna

    2016-11-01

    Berries belong to the best dietary sources of bioactive compounds, which exert a synergistic and cumulative effect on promotion of human health and prevention of diseases. The present review presents the most recent findings of animal and human studies regarding the health benefits of berries in terms of prevention and treatment of obesity, hypertension, type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease. In the last years, there was a growing number of evidence from human epidemiological and interventional studies, which emphasized the role of berries in the management of metabolic diseases. Based on the results from recent clinical trials, it can be established that a berry diet rich in antioxidants and bioactive phytochemicals has beneficial effects on hepatic function, increase of insulin sensitivity and high-density lipoprotein-cholesterol, decrease of serum glucose and low-density lipoprotein-cholesterol, and finally is inversely associated with the incidence of type 2 diabetes. Numerous recent studies have shown that berries provide great benefits in preventing or mitigating metabolic disorders. The results of this review indicate that regular long-term consumption of different berries could potentially delay the progression of metabolic syndrome and comorbidities.

  1. Metabolic syndrome and subsequent risk of type 2 diabetes and cardiovascular disease in elderly women Challenging the current definition

    DEFF Research Database (Denmark)

    Møller, Katrine Dragsbæk; Neergaard, Jesper; Laursen, Janne Marie

    2016-01-01

    The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM......, followed 3905 Danish women since 2000 (age: 70.1±6.5) with no previous diagnosis of T2DM or CVD, holding all measurements used for MetS definition; central obesity, hypertension, hyperlipidemia, and hyperglycemia combined with register-based follow-up information. Elderly women with defined MetS presented...... a 6.3-fold increased risk of T2DM (95% confidence interval: [3.74-10.50]) and 1.7-fold increased risk of CVD (1.44-2.05) compared to women with no MetS risk factors. Subdividing the control group without defined MetS revealed that both centrally obese controls and controls holding other MetS risk...

  2. Abc-frame complex-coefficient filter and controller based current harmonic elimination strategy for three-phase grid connected inverter

    DEFF Research Database (Denmark)

    Guo, Xiaoqiang; Guerrero, Josep M.

    2016-01-01

    Current quality is one of the most important issues for operating three-phase grid-connected inverter in distributed generation systems. In practice, the grid current quality is degraded in case of non-ideal utility voltage. A new control strategy is proposed for the three-phase gridconnected...... inverter. Different from the traditional method, our proposal utilizes the unique abc-frame complex-coefficient filter and controller to achieve the balanced, sinusoidal grid current. The main feature of the proposed method is simple and easy to implement without any frame transformation. The theoretical...

  3. Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

    Science.gov (United States)

    Robinson, M; Palmer, S; Sculpher, M; Philips, Z; Ginnelly, L; Bowens, A; Golder, S; Alfakih, K; Bakhai, A; Packham, C; Cooper, N; Abrams, K; Eastwood, A; Pearman, A; Flather, M; Gray, D; Hall, A

    2005-07-01

    To identify and prioritise key areas of clinical uncertainty regarding the medical management of non-ST elevation acute coronary syndrome (ACS) in current UK practice. Electronic databases. Consultations with clinical advisors. Postal survey of cardiologists. Potential areas of important uncertainty were identified and 'decision problems' prioritised. A systematic literature review was carried out using standard methods. The constructed decision model consisted of a short-term phase that applied the results of the systematic review and a long-term phase that included relevant information from a UK observational study to extrapolate estimated costs and effects. Sensitivity analyses were undertaken to examine the dependence of the results on baseline parameters, using alternative data sources. Expected value of information analysis was undertaken to estimate the expected value of perfect information associated with the decision problem. This provided an upper bound on the monetary value associated with additional research in the area. Seven current areas of clinical uncertainty (decision problems) in the drug treatment of unstable angina patients were identified. The agents concerned were clopidogrel, low molecular weight heparin, hirudin and intravenous glycoprotein antagonists (GPAs). Twelve published clinical guidelines for unstable angina or non-ST elevation ACS were identified, but few contained recommendations about the specified decision problems. The postal survey of clinicians showed that the greatest disagreement existed for the use of small molecule GPAs, and the greatest uncertainty existed for decisions relating to the use of abciximab (a large molecule GPA). Overall, decision problems concerning the GPA class of drugs were considered to be the highest priority for further study. Selected papers describing the clinical efficacy of treatment were divided into three groups, each representing an alternative strategy. The strategy involving the use of GPAs

  4. Cogan's syndrome is a new nosological entity in the current classification of systemic vasculitides: A clinical case and a review of literature

    Directory of Open Access Journals (Sweden)

    T. V. Beketova

    2016-01-01

    Full Text Available The paper describes a clinical case of the typical variant of Cogan's syndrome (CS, a new nosological entity in the current classification of systemic vasculitides (SV, which belongs to a group of variable vasculitides. The literature review highlights in detail the problems of the diagnosis and treatment of this rare disease.CS is characterized by inflammatory eye involvement (interstitial keratitis, uveitis, and episcleritis and hearing problems (sensorineural hearing loss, vestibular disorders with the possible development of vasculitis at other sites, aortitis, and aortic or mitral lesions. A systemic lesion involving the ears and eyes necessitates to rule out granulomatosis with polyangiitis (Wegener's and to make a differential diagnosis with a wide range of diseases. The given data underline the need for the interdisciplinary collaboration of rheumatologists, otorhinolaryngologists, audiologists, oculists, and cardiologists in order to improve the diagnosis and treatment of this form of SV. 

  5. Low Tidal Volume versus Non-Volume-Limited Strategies for Patients with Acute Respiratory Distress Syndrome. A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Walkey, Allan J; Goligher, Ewan C; Del Sorbo, Lorenzo; Hodgson, Carol L; Adhikari, Neill K J; Wunsch, Hannah; Meade, Maureen O; Uleryk, Elizabeth; Hess, Dean; Talmor, Daniel S; Thompson, B Taylor; Brower, Roy G; Fan, Eddy

    2017-10-01

    Trials investigating use of lower tidal volumes and inspiratory pressures for patients with acute respiratory distress syndrome (ARDS) have shown mixed results. To compare clinical outcomes of mechanical ventilation strategies that limit tidal volumes and inspiratory pressures (LTV) to strategies with tidal volumes of 10 to 15 ml/kg among patients with ARDS. This is a systematic review and meta-analysis of clinical trials investigating LTV mechanical ventilation strategies. We used random effects models to evaluate the effect of LTV on 28-day mortality, organ failure, ventilator-free days, barotrauma, oxygenation, and ventilation. Our primary analysis excluded trials for which the LTV strategy was combined with the additional strategy of higher positive end-expiratory pressure (PEEP), but these trials were included in a stratified sensitivity analysis. We performed metaregression of tidal volume gradient achieved between intervention and control groups on mortality effect estimates. We used Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the quality of evidence. Seven randomized trials involving 1,481 patients met eligibility criteria for this review. Mortality was not significantly lower for patients receiving an LTV strategy (33.6%) as compared with control strategies (40.4%) (relative risk [RR], 0.87; 95% confidence interval [CI], 0.70-1.08; heterogeneity statistic I 2  = 46%), nor did an LTV strategy significantly decrease barotrauma or ventilator-free days when compared with a lower PEEP strategy. Quality of evidence for clinical outcomes was downgraded for imprecision. Metaregression showed a significant inverse association between larger tidal volume gradient between LTV and control groups and log odds ratios for mortality (β, -0.1587; P = 0.0022). Sensitivity analysis including trials that protocolized an LTV/high PEEP cointervention showed lower mortality associated with LTV (nine trials and 1

  6. Ranking current and prospective NO2 pollution mitigation strategies: An environmental and economic modelling investigation in Oxford Street, London.

    Science.gov (United States)

    Jeanjean, A P R; Gallagher, J; Monks, P S; Leigh, R J

    2017-06-01

    Air pollution continues to be a problem in the urban environment. A range of different pollutant mitigation strategies that promote dispersion and deposition exist, but there is little evidence with respect to their comparative performance from both an environmental and economic perspective. This paper focuses on examining different NO 2 mitigation strategies such as trees, buildings facades coated with photocatalytic paint and solid barriers in Oxford Street in London. The case study findings will support ranking the environmental and economic impacts of these different strategies to improve personal exposure conditions on the footpath and on the road in a real urban street canyon. CFD simulations of airflow and NO 2 dispersion in Oxford Street in London were undertaken using the OpenFOAM software platform with the k-ε model, taking into account local prevailing wind conditions. Trees are shown to be the most cost-effective strategy, with a small reduction in NO 2 concentrations of up to 0.7% on the road. However, solid barriers with and without the application of photocatalytic paint and an innovative material (20 times more expensive than trees) can improve air quality on the footpaths more substantially, up to 7.4%, yet this has a significant detrimental impact on NO 2 concentrations (≤23.8%) on the road. Photocatalytic paint on building surfaces presented a minimal environmental reductions (1.2%) and economic (>100 times more expensive than trees) mitigation strategy. The findings recognised the differences between footpath and road concentrations occurred and that a focused examination of three pollution hotspots can provide more cost effective pollution mitigation. This study considers how a number of pollutant mitigation measures can be applied in a single street canyon and demonstrates the strengths and weaknesses of these strategies from economic and environmental perspectives. Further research is required to extrapolate the findings presented here to

  7. Evaluation of current prediction models for Lynch syndrome: updating the PREMM5 model to identify PMS2 mutation carriers.

    Science.gov (United States)

    Goverde, A; Spaander, M C W; Nieboer, D; van den Ouweland, A M W; Dinjens, W N M; Dubbink, H J; Tops, C J; Ten Broeke, S W; Bruno, M J; Hofstra, R M W; Steyerberg, E W; Wagner, A

    2018-07-01

    Until recently, no prediction models for Lynch syndrome (LS) had been validated for PMS2 mutation carriers. We aimed to evaluate MMRpredict and PREMM5 in a clinical cohort and for PMS2 mutation carriers specifically. In a retrospective, clinic-based cohort we calculated predictions for LS according to MMRpredict and PREMM5. The area under the operator receiving characteristic curve (AUC) was compared between MMRpredict and PREMM5 for LS patients in general and for different LS genes specifically. Of 734 index patients, 83 (11%) were diagnosed with LS; 23 MLH1, 17 MSH2, 31 MSH6 and 12 PMS2 mutation carriers. Both prediction models performed well for MLH1 and MSH2 (AUC 0.80 and 0.83 for PREMM5 and 0.79 for MMRpredict) and fair for MSH6 mutation carriers (0.69 for PREMM5 and 0.66 for MMRpredict). MMRpredict performed fair for PMS2 mutation carriers (AUC 0.72), while PREMM5 failed to discriminate PMS2 mutation carriers from non-mutation carriers (AUC 0.51). The only statistically significant difference between PMS2 mutation carriers and non-mutation carriers was proximal location of colorectal cancer (77 vs. 28%, p PMS2 mutation carriers (AUC 0.77) and overall (AUC 0.81 vs. 0.72). We validated these results in an external cohort of 376 colorectal cancer patients, including 158 LS patients. MMRpredict and PREMM5 cannot adequately identify PMS2 mutation carriers. Adding location of colorectal cancer to PREMM5 may improve the performance of this model, which should be validated in larger cohorts.

  8. The Low-FODMAP diet in the Irritable Bowel Syndrome: Is it currently an ineffective nutritional treatment? Symptomatic improvement

    Directory of Open Access Journals (Sweden)

    Cristina Álvarez Díaz

    2017-10-01

    Full Text Available Introductions: Irritable bowel syndrome (IBS is one of the most prevalent functional gastrointestinal disorders in the population. It is a complex and multifactorial disease in which biological, psychological and social factors act at multiple levels on the disease. Diagnosed according to ROMA IV and characterized mainly by abdominal pain and change in bowel habits, it does not have a standard treatment, so it focuses on minimizing gastrointestinal symptoms. The FODMAP diet has been appeared as an effective treatment of IBS. Objectives: The main objective of this study was to test the efficacy of the FODMAP diet in its different phases of nutrition therapy in order to reduce gastrointestinal symptoms and to increase quality of life. Methods: A prospective experimental study with duration of twelve weeks was designed under one case, a 35-year-old woman suffering from IBS for 7 years. The dietary treatment was divided into three phases, which was being realised with 12 different diets, dietary education and dietary advice, assessment symptoms, quality of life, type of stool, diet adherence and satisfaction about the nutrition therapy. Results: The gastrointestinal symptoms and quality of life improved in comparison to the start of the study, as well did the stool in outbreak crisis and routinely situations. By contrast, no relation between the reintroduced foods that produced symptoms with FODMAP’s content was found. Conclusions: The nutritional treatment of FODMAP diet is an effective treatment for IBS because it reduces the gastrointestinal symptoms, increases the quality of life and the control of the patient towards the diet.

  9. Antiarrhythmic properties of a rapid delayed-rectifier current activator in rabbit models of acquired long QT syndrome

    DEFF Research Database (Denmark)

    Diness, Thomas G; Yeh, Yung-Hsin; Qi, Xiao Yan

    2008-01-01

    effect of a novel compound (NS1643) that activates the rapid delayed-rectifier K+ current, I(Kr), in two rabbit models of acquired LQTS. METHODS AND RESULTS: We used two clinically relevant in vivo rabbit models of TdP in which we infused NS1643 or vehicle: (i) three-week atrioventricular block...

  10. [Burnout Syndrome, Family and Work Related Variables on General Practitioners in Bogota. A Strategy of Work Quality].

    Science.gov (United States)

    Aguirre Roldán, Adriana María; Quijano Barriga, Ana María

    2015-01-01

    The burnout syndrome is a set of work-related symptoms related to weariness and exhaustion, in response to the emotional stress at work and its consequences. The aim of the study was to measure the frequency of burnout in General Practitioners (GPs) from 3 private institutions in Bogotá, Colombia and to determine the associated factors according to the variables taken into account. It is a descriptive cross-sectional study which was used to analyse the Questionnaire for Burnout Syndrome (CESQT). The population was 106 GPs. The level of burnout was at a critical level in 6.6% of the GP population. The variables showed that having a stable partner and children are a protective factor. By contrast, work in emergency rooms is a risk factor. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  11. Congenital Short QT Syndrome

    Directory of Open Access Journals (Sweden)

    Lia Crotti

    2010-02-01

    Full Text Available The Short QT Syndrome is a recently described new genetic disorder, characterized by abnormally short QT interval, paroxysmal atrial fibrillation and life threatening ventricular arrhythmias. This autosomal dominant syndrome can afflict infants, children, or young adults; often a remarkable family background of cardiac sudden death is elucidated. At electrophysiological study, short atrial and ventricular refractory periods are found, with atrial fibrillation and polymorphic ventricular tachycardia easily induced by programmed electrical stimulation. Gain of function mutations in three genes encoding K+ channels have been identified, explaining the abbreviated repolarization seen in this condition: KCNH2 for Ikr (SQT1, KCNQ1 for Iks (SQT2 and KCNJ2 for Ik1 (SQT3. The currently suggested therapeutic strategy is an ICD implantation, although many concerns exist for asymptomatic patients, especially in pediatric age. Pharmacological treatment is still under evaluation; quinidine has shown to prolong QT and reduce the inducibility of ventricular arrhythmias, but awaits additional confirmatory clinical data.

  12. [Obesity and metabolic syndrome in adolescents].

    Science.gov (United States)

    Cárdenas Villarreal, Velia Margarita; Rizo-Baeza, María M; Cortés Castell, Ernesto

    2009-03-01

    In spite of the lack of a uniform definition for metabolic syndrome in pediatry, recent studies have shown that it develops during childhood and is highly prevalent among children and adolescents who suffer from obesity. In light of the current epidemic of obesity in this age category in western countries, and specifically in Mexico, it becomes essential to know the means to prevent, detect and treat this syndrome. Nurses play an important role in promoting childhood health with regards to metabolic syndrome. To put into practice the strategies which resolve underlying problems related with this syndrome is a priority for the well-being of this age group. These strategies should include the application and management of public policies; the collaboration by health services, social services and schools; but, furthermore, the prevention and the management of this syndrome require a family commitment, while the changes in living habits benefit the entire family. This review article proposes to introduce prevention, diagnostic and treatment strategies which nursing personnel can carry out while dealing with metabolic syndrome in adolescents.

  13. A new dietary strategy for long-term treatment of the metabolic syndrome is compared with the American Heart Association (AHA) guidelines: the MEtabolic Syndrome REduction in NAvarra (RESMENA) project.

    Science.gov (United States)

    de la Iglesia, Rocio; Lopez-Legarrea, Patricia; Abete, Itziar; Bondia-Pons, Isabel; Navas-Carretero, Santiago; Forga, Luis; Martinez, J Alfredo; Zulet, M Angeles

    2014-02-01

    The long-term effects of dietary strategies designed to combat the metabolic syndrome (MetS) remain unknown. The present study evaluated the effectiveness of a new dietary strategy based on macronutrient distribution, antioxidant capacity and meal frequency (MEtabolic Syndrome REduction in NAvarra (RESMENA) diet) for the treatment of the MetS when compared with the American Heart Association guidelines, used as Control. Subjects with the MetS (fifty-two men and forty-one women, age 49 (se 1) years, BMI 36·11 (se 0·5) kg/m²) were randomly assigned to one of two dietary groups. After a 2-month nutritional-learning intervention period, during which a nutritional assessment was made for the participants every 15 d, a 4-month self-control period began. No significant differences were found between the groups concerning anthropometry, but only the RESMENA group exhibited a significant decrease in body weight ( - 1·7%; P= 0·018), BMI ( - 1·7%; P= 0·019), waist circumference ( - 1·8%; P= 0·021), waist:hip ratio ( - 1·4%; P= 0·035) and android fat mass ( - 6·9%; P= 0·008). The RESMENA group exhibited a significant decrease in alanine aminotransferase and aspartate aminotransferase (AST) concentrations ( - 26·8%; P= 0·008 and - 14·0%; P= 0·018, respectively), while the Control group exhibited a significant increase in glucose (7·9%; P= 0·011), AST (11·3%; P= 0·045) and uric acid (9·0%; Ptreatment for the MetS.

  14. Nonspecific non-acute low back pain and psychological interventions: A review of evidence and current strategies

    Directory of Open Access Journals (Sweden)

    Gourav Banerjee

    2015-01-01

    Full Text Available Nonspecific persistent and chronic low back pain (LBP is one of the world′s most significant burdens. Its management continues to be challenging despite advancements in medical diagnostics and therapeutics. The purpose of this narrative review is to update evidence-based, multidisciplinary assessment and treatment strategies for nonspecific non-acute LBP with special emphasis on the growing influence of psychological principles in physiotherapists′ (PT practice. An electronic literature search was performed to identify relevant clinical practice guidelines, from which an overarching summary was synthesized. All guidelines were consistent in their recommendations for the assessment of psychosocial factors and psychology-based interventions. In discussion, we underlined psychological processes and psychology-based strategies that are clinically relevant to, and within the professional competency and scope of PT practice.

  15. New strategy for eliminating zero-sequence circulating current between parallel operating three-level NPC voltage source inverters

    DEFF Research Database (Denmark)

    Li, Kai; Dong, Zhenhua; Wang, Xiaodong

    2018-01-01

    buses, that are operating in parallel. First, an equivalent model of ZSCC in a three-phase three-level NPC inverter paralleled system is developed. Second, on the basis of the analysis of the excitation source of ZSCCs, i.e., the difference in common mode voltages (CMVs) between paralleled inverters......, the ZCMV-PWM method is presented to reduce CMVs, and a simple electric circuit is adopted to control ZSCCs and neutral point potential. Finally, simulation and experiment are conducted to illustrate effectiveness of the proposed strategy. Results show that ZSCCs between paralleled inverters can...... be eliminated effectively under steady and dynamic states. Moreover, the proposed strategy exhibits the advantage of not requiring carrier synchronization. It can be utilized in inverters with different types of filter....

  16. Accelerated inactivation of the L-type calcium current due to a mutation in CACNB2b underlies Brugada syndrome

    DEFF Research Database (Denmark)

    Cordeiro, Jonathan M; Marieb, Mark; Pfeiffer, Ryan

    2009-01-01

    S in which loss of function is caused by accelerated inactivation of I(Ca). The proband, a 32 year old male, displayed a Type I ST segment elevation in two right precordial ECG leads following a procainamide challenge. EP study was positive with induction of polymorphic VT/VF. Interrogation of implanted ICD...... significantly faster in mutant channels between 0 and + 20 mV. Action potential voltage clamp experiments showed that total charge was reduced by almost half compared to WT. We report the first BrS mutation in CaCNB2b resulting in accelerated inactivation of L-type calcium channel current. Our results suggest...

  17. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.

    Science.gov (United States)

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Clayton, Tim; Pocock, Stuart J; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN

  18. Recombinant Endolysins as Potential Therapeutics against Antibiotic-Resistant Staphylococcus aureus: Current Status of Research and Novel Delivery Strategies.

    Science.gov (United States)

    Haddad Kashani, Hamed; Schmelcher, Mathias; Sabzalipoor, Hamed; Seyed Hosseini, Elahe; Moniri, Rezvan

    2018-01-01

    Staphylococcus aureus is one of the most common pathogens of humans and animals, where it frequently colonizes skin and mucosal membranes. It is of major clinical importance as a nosocomial pathogen and causative agent of a wide array of diseases. Multidrug-resistant strains have become increasingly prevalent and represent a leading cause of morbidity and mortality. For this reason, novel strategies to combat multidrug-resistant pathogens are urgently needed. Bacteriophage-derived enzymes, so-called endolysins, and other peptidoglycan hydrolases with the ability to disrupt cell walls represent possible alternatives to conventional antibiotics. These lytic enzymes confer a high degree of host specificity and could potentially replace or be utilized in combination with antibiotics, with the aim to specifically treat infections caused by Gram-positive drug-resistant bacterial pathogens such as methicillin-resistant S. aureus . LysK is one of the best-characterized endolysins with activity against multiple staphylococcal species. Various approaches to further enhance the antibacterial efficacy and applicability of endolysins have been demonstrated. These approaches include the construction of recombinant endolysin derivatives and the development of novel delivery strategies for various applications, such as the production of endolysins in lactic acid bacteria and their conjugation to nanoparticles. These novel strategies are a major focus of this review. Copyright © 2017 American Society for Microbiology.

  19. Evaluation of alternative strategies to MERV 16-based air filtration systems for reduction of the risk of airborne spread of porcine reproductive and respiratory syndrome virus.

    Science.gov (United States)

    Dee, Scott; Pitkin, Andrea; Deen, John

    2009-07-02

    Porcine reproductive and respiratory syndrome (PRRS) is a re-emerging disease of pigs and a growing threat to the global swine industry. For sustainable disease control it is critical to prevent the airborne spread of the etiologic agent, PRRS virus, between pig populations. The application of MERV 16-based air filtration systems to swine facilities in an effort to reduce this risk has been proposed; however, due to the cost and air flow restrictions of such systems the need for alternative strategies has arisen. Therefore, the objective of this study was to evaluate 3 groups of alternative biosecurity strategies for reducing the risk of the airborne spread of PRRSV. Strategies evaluated included mechanical filters, antimicrobial filters and a disinfectant-EVAP (evaporative cooling) system. Results from this study indicate that while alternatives to MERV 16-based biosecurity protocols for protecting farms from the airborne spread of PRRSV are available, further information on their efficacy in the field is needed before conclusions can be drawn.

  20. 10-Year Mortality Outcome of a Routine Invasive Strategy